Tubes and Wires on a Premature Baby

Start by separating monitoring from treatment

The first look at a baby covered in wires is the worst moment most parents have on a neonatal unit, and a large part of what you are seeing is not doing anything to your baby at all. It is watching. Sorting the attachments into "measuring" and "giving" makes the cot side legible almost immediately.

The three sticky dots on the chest

These are the leads for the vital signs monitor. Bliss describes them as small pads that pick up the electrical signals from your baby's heart and changes in breathing, with wires running to the machine. They measure. They do not deliver anything. They come off for cuddles and go back on afterwards, and the wires are long enough for skin-to-skin.

The light on the foot or hand

This is the oxygen saturation probe. Bliss explains that it shines a light through the skin to measure how much oxygen the blood is carrying, and it is strapped gently rather than stuck. It glows red, which unnerves people, and it is one of the commonest causes of false alarms because it slips when a baby wriggles.

The tube taped to the cheek

If it goes into a nostril or the mouth and is taped to the cheek, it is almost certainly a feeding tube — nasogastric if through the nose, orogastric if through the mouth. Bliss explains that milk is given through it when a baby cannot yet feed by themselves. Before every feed, a nurse draws back a little stomach content and tests it with pH paper to confirm the tube is in the right place; that is the "checking the aspirate" you will hear.

A different, thicker tube going into the mouth or nose and connected to a machine at the head of the cot is an endotracheal tube, which carries air from a ventilator into the windpipe. It is easy to tell them apart: the feeding tube is thin and taped to the face, the breathing tube is thicker and attached to tubing.

The drip in a hand, foot or scalp

A cannula is a short, soft plastic tube in a small vein, used to give fluids and medicines without repeated needles. Bliss notes that the veins of the arms and legs are usually used but that scalp veins sometimes have to be, which shocks parents and is not a sign of anything worse. A cannula can last several days or need changing within hours.

Umbilical lines

In the first few days you may see lines emerging from the cord stump. Bliss describes umbilical catheters as long soft tubes placed into the blood vessels of the belly button: the arterial one is used to measure blood pressure and take blood samples for gases, and the venous one gives nutrition or medicines. They are placed without cutting and the cord stump has no nerve endings, so insertion does not hurt. They are usually removed within the first week.

Long lines

A long line is a very thin tube threaded through a small vein until its tip sits in a larger one, used mainly for parenteral nutrition and some medicines. Bliss notes that placing one can be fiddly in a very small baby, and that it is often done in sterile conditions where you may be asked to step away. It saves your baby repeated cannulas, which is the whole point of it.

Which of these hurt

Honestly: putting a cannula or a long line in is uncomfortable, and heel pricks are uncomfortable. Having them in place is not. Bliss is explicit that tests and procedures are only done when needed, that staff try to reduce pain and disturbance, and that during procedures you can comfort your baby — cradling their hands and feet, skin-to-skin, or a dummy with a little expressed milk. That is a real analgesic effect, not a gesture, and you are allowed to ask to be there for it.

Cuddles are still possible

Parents assume the wires forbid holding. They usually do not. Units routinely move ventilated babies for kangaroo care with two staff, and comfort holding — a still, cupped hand over the head and feet rather than stroking — is offered for babies not yet ready to be lifted. NICE NG124 tells staff to explain the benefits of touch, including skin-to-skin, and to recognise parents as partners in their baby's care. If nobody has offered a cuddle, ask when the first one can happen.

Things coming out is the progress you can see

The order is fairly predictable: umbilical lines go in the first week, the breathing tube goes when your baby manages on CPAP, the long line goes when milk feeds are established, the cannula goes when the antibiotics stop, and the feeding tube is the last to leave, often only days before discharge. Not every removal sticks first time. A tube that has to go back in is a bad day, not a lost fortnight.

Two things worth asking

Ask what each attachment is for by name, once, so that you can see at a glance whether anything has been added overnight. And ask what has to be true for each one to come out. It converts a frightening tangle into a checklist you can watch getting shorter.

What the alarms mean, and what they mostly mean

Alarm limits are set deliberately tight, so most alarms are not events. A slipped saturation probe, a sticky dot that has lifted, a baby who has wriggled or is having a good stretch will all set something off. Staff read the trend on the screen and the baby in the cot rather than the noise, and within about a week most parents find they are doing the same.

There is one exception worth knowing. Bliss says that if you think your baby has stopped breathing there is an emergency call button somewhere around the incubator or cot, and pressing it is the right thing to do. Nobody will think you foolish for pressing it.

Nappies, mouth care and the jobs that are yours

The wires make it look as though there is nothing for you to do. There is. Nappy changes, mouth care with your own expressed milk on a small swab, taking a temperature, helping with position changes and giving tube feeds are all things parents are taught, and units actively want you doing them. NICE NG124 tells staff to encourage and support parents to be involved in planning and providing their baby's day-to-day care.

Doing the cares also changes how the equipment feels. Once you have reached past a saturation probe fifty times to change a nappy, it stops being frightening and becomes furniture.