T-Piece Resuscitator:  To Use or Not To Use?

by Tina Ly, BSN, RNC-NIC

Purpose

The purpose of this project is to determine if educating clinicians on the T-piece resuscitator (TPR) in a simulation-type setting will improve their confidence in providing efficient and effective resuscitation of term neonates requiring positive pressure ventilation (PPV).

Background

Approximately 10% of all newborns require some assistance to start breathing at birth, and the American Academy of Pediatrics has advised that the most important and effective action in neonatal resuscitation is to ventilate the baby’s lungs.  UCSF’s Neonatal Team uses the flow-inflating bag (FIB) for resuscitation, which can be cumbersome to use especially for the novice user.  There is more room for error using the FIB because the pressure of each breath delivered depends on the manual squeeze of the clinician’s hand.  The TPR has been shown in multiple studies to be easier to use across clinician experience levels and proven to be the most accurate in the pressures it delivers with each breath.

Methods

A pre-intervention survey was sent out to clinicians involved in resuscitation of the term neonate to measure confidence levels of efficient and effective resuscitation with the FIB.  Efficient resuscitation was measured by the time it takes to obtain an adequate seal with a facemask.  Effective resuscitation was measured by the ability to deliver desired pressures with every breath provided.   Clinician confidence was self-reported.  Education was provided in a simulation-type setting and each clinician was evaluated on the safe use of the TPR.  After the education component was provided, clinicians were asked to report their confidence levels regarding TPR use and a 2-month trial of the TPR was implemented in the live birth setting.  After each resuscitation, clinicians completed a short survey to gather data about the device with which they started, if they switched devices during resuscitation, and which device they would choose for the next resuscitation.

Results

Survey data revealed that 15% of clinicians felt no confidence in obtaining an adequate seal in less than 5 seconds with the FIB; this dropped to 2% with TPR.  Five percent felt no confidence in obtaining an adequate seal in less than 10 seconds and 20% felt no confidence in delivering breaths at their desired pressure with every attempt.  After education on the TPR, these no confidence responses were eliminated in both categories.  During the two-month live trial, there were 208 reported deliveries attended by the Neonatal Team.  At least 54 of those required resuscitation.  Clinician feedback revealed that 96% used the TPR to begin resuscitation with just 17% switching to the FIB.  Eighty-seven percent of clinicians would choose the TPR for the next resuscitation. 

Discussion

Education on the TPR improved clinician confidence in delivering efficient and effective resuscitation of the term neonate requiring PPV.  Regardless of device selection, continued education is key.  The TPR is now included in annual review for all charge and triage nurses in the Intensive Care Nursery, all nurses in Labor & Delivery, orientation and skills refresher courses for the residents, and Mock Codes which involves nurses and residents.