Did you know 4-handed care (2-person caregiving) significantly reduces mean heart rate during and after suctioning compared to 2-handed care?

               Pain is the fifth vital sign with short-term and long-term effects for the infant in the NICU. Pain decreases oxygenation, causes hemodynamic instability, increased intracranial pressure, leads to anxiety, stress, hyperactivity and attention issues.  Many pharmacologic pain management strategies are utilized but medications may have side effects. As an alternative or adjunct to pharmacologic pain management, non-pharmacologic strategies include swaddling, skin-to-skin holding, non-nutritive sucking, sucrose, and gentle human touch.

               In a 2022 article, researchers aimed to examine the effect of four-handed care on pain and stress during endotracheal suctioning.  In this randomized crossover clinical trial, 40 infants aged 29-37 weeks postmenstrual age in the NICU were observed during endotracheal suctioning in the traditional two-handed vs four-handed approach. The four-handed method involved a second caregiver who supported the infant in its position, provided gentle human touch, and assisted the other caregiver in gathering supplies. The ALPS-Neo (Astrid Lindgren Children’s Hospital Pain Scale) and camera recording was used to examine the results.

               Results showed no significant results between the two methods related to arterial oxygenation or behavioral response but showed a significant difference in the mean heart rate during and after suctioning with four-handed care. Since increased heart rate can increase stress and behavior, and increased heart rate is a measure of pain, researchers recommend providing four-handed care for suctioning. Authors also suggested that future research is needed to examine four-handed care with other care activities in the NICU as human touch is known to be calming and comforting.

Is 4-handed care a standard care practice in your unit? Learn more about 4-handed caregiving and get a chance to practice this technique, along with a variety of other neuroprotective and neuropromotional activities like swaddled bathing, skin-to-skin transfers, and neonatal massage during your Neonatal Touch & Massage Certification Hands-On Training. Learn more here! 

Niaraki, S., Pouraboli, B., Fakhr, A., Mirlashari, J., Ranjbar, H. (2022). The Effect of Endotracheal Suctioning Using the Four-handed Care on Physiological Criteria and Behavioral Responses of the Preterm Infants: Randomized Crossover Clinical Trial. J Caring Sci. doi: 10.34172/jcs2022.09.