451 - Confirmation of Less Invasive Surfactant Administration Catheter Placement by Capnography

Publication Number: 451.4325

Kimberly Miklis, Baylor Scott and White University Medical Center, Dallas, TX, United States; Callie Turner, Baylor University Medical Center, Dallas, TX, United States; Matthew J. Hawke, Baylor University Medical Center, Plano, TX, United States; Amy Reedy, Baylor Scott & White Medical Center of McKinney, McKinney, TX, United States; Jordan Reis, Texas A&M Health Science Center College of Medicine, Dallas, TX, United States; Arpitha Chiruvolu, Baylor University Medical Center, Dallas, TX, United States

Background: Less Invasive Surfactant Administration (LISA) is a preferred method to deliver surfactant in infants receiving non-invasive ventilation. Intubation with endotracheal tube (ETT) is usually confirmed by improvement in heart rate, visualization of mist in the tube, and auscultation of breath sounds. Unfortunately, it is not possible to confirm LISA catheter by these methods. In our practice, we used common methods of evaluating LISA catheter placement include direct visualization and aspiration of gastric contents via orogastric tube after second and fourth aliquot administration of surfactant. Catheter placement is presumed successful if significant volume of surfactant is not aspirated from the stomach. However, drawbacks of this method include by the time gastric aspiration is performed, surfactant is wasted if catheter is not in the trachea and aspiration of gastric contents by itself may be harmful, especially in extremely premature infants.

Colorimetric carbon dioxide (CO2) detectors have been in use in the neonatal population for long time. Capnography is a routine and reliable method to confirm the placement of ETT after intubation. However, the CO2 detector is not routinely used for confirmation of LISA catheter placement.

Objective: To determine the reliability of capnography in confirming placement of endotracheal LISA catheter utilizing a colorimetric CO2 detector. We hypothesized that this method would result in a true positive rate of 100%.

Design/Methods: In our practice, CO2 detection was introduced into the LISA guideline on August 15, 2024. The steps include a) After placement of the LISA catheter, attach a pediatric colorimetric CO2 detector via a 3.0 ETT connector b) Wait for up to 6 spontaneous breaths for the color change c) Note if the color changes to yellow d) Remove CO2 detector and connector e) Proceed with the surfactant administration and aspiration of gastric contents per guideline.

Results: To date, 25 LISA procedures have been performed utilizing CO2 detector. Gestational age at birth ranged between 26 and 40 weeks. All procedures resulted in positive capnography. On gastric aspiration, significant surfactant was not obtained and there was appropriate clinical response. With all the procedures yielding true positive results and none being false negative, the true positive rate is 100%.

Conclusion(s): Capnography via pediatric colorimetric CO2 detector can be safely and reliably utilized in the LISA procedure to confirm endotracheal catheter placement.

PIcture 1 LISA supplies
Supplies for LISA: 1) CO2 detector, 2) 3.0 ETT connector (ETT removed), 3)16g Angiocath (LISA catheter),

PIcture 2 LISA set up
After placement of LISA catheter, attach 3.0 ETT connector and CO2 detector (as one unit).

Picture 3 LISA set up
After color change, remove the CO2 detector and ETT adaptor then proceed with surfactant administration.