Sun*shine 3,633 Views
Joined: Jul 23, '07;
Posts: 103 (13% Liked)
; Likes: 13
Congratulations on your interview. I'm an Adult Nurse who started in neonates last year. Are you a nurse in the UK? Someone on the forums suggested I read The Department of Health Toolkit for High Quality Neonatal Services. It's from 2009 but gave me a good insight into the goals of neonatal units and might give you an idea for your presentation. Part of it is about the family experience. As a neonatal nurse you'll spend a great deal of time giving nursing care to the grown ups as well as the babies, which is great because you're highly experienced in this as an icu nurse. It was a topic I found I could get my teeth into.
All your comments have been really intersting and helpful. Honestly it's so good to get people's insight into suction practice in different units. I feel more confident now with it, although I'll still be asking someone to stand by me until I feel ready to do it on my own.
Ah, so would 'sounding crunchy' (love that term btw) alone give cause for suction, or would you not go there until you've got other clinical features alongside it?
Thank you all for making me feel better about asking for help with suctioning. I felt like by now I should be able to do such a basic thing as this on my own. Reading your comments has helped me realise that suction is neither basic nor straightforward.
I couldn't fathom why we didn't have in-line suction but when I asked around the nurses said that in-line suction doesn't work as well as disconnecting the vent. I've never used inline so I wouldn't know.
Nicugal I'd love to read through a protocol like that.
I don't have that clinical judgement yet as to when not to suction if I'm asked to. Generally every time a baby has a bad gas the first intervention the doctors would like is suction. I've known them to want it doing even if it was only done recently "just to see what's there". So I can see where you're coming from Bortaz.
When I ask people if I should be suctioning or not they often tell me 'have a listen to their chest.' Fair enough if anything clinically has changed or if they sounds particularly bad then I'd suction them. But if their ventilation and Fi02 hasn't changed and Sp02 is steady away...then do you suction just because you can hear secretions? I think that in some babies you can always hear them, especially when they've got bad RDS. Do you wait until the secretions become a problem?
I wish we had in-line suction. We don't have chest physios based on the unit, they'll only come if there is a real concern about an infant's respiratory state. Physios don't see ventilated babies as routine. Now I think about it I find this odd, because chest physios would see everyone in an adult icu. Thanks for explaining the saline part I know now not to use it every time.
Thanks for your replies Nurse4sale that's reassuring to know, if anyone offers to do it for me I leap for joy and let them. Not good for me in the long term. And I feel embarrassed asking for help now because I don't want anyone to think I'm incompetent. Well done for getting over your fear. K+MgSO4 yes we have a clinical educator and I think I'll have a chat with her about it. She’s not based at our hospital and it’s rare that we see her so I guess that’s why I’ve not gone to her yet. But she’s brilliant and I’m sure she’d make a point of coming to see me though if I asked for help. Cerriwin we don't use in line catheters, so it's quite 'fiddily' in my opinion. I think it adds to the pressure when you're having to take the vent off. I really could be done with a third hand.
Can you use ear bud cotton sticks instead for tiny wee premie mouths?
Hello. I'm really new to neonates and I'm loving it so far. My main concern is I'm underconfident when it comes to suctioning a Et tube.
I know how to do it, but I struggle with when to do it, if I should use saline, how many times I should do go down etc. I ask for help every time I need to suction a baby but our unit is really busy and at times no one is available. I'm also aware that the more I ask for help, the more I'm finding myself never wanting to do it on my own.
Does anyone know of any resources online that are helpful in this topic?
Interesting topic, thanks for bringing it up. Our unit does this, but not every baby with a CVC gets Nystatin, there are a set of risk factors that indiciate its use. We put 0.5ml down the NG and 0.5ml in the mouth. I feel that 0.5ml in the mouth of our tiny prems is a large volume. We use pink oral sponges to apply it (same size I used on adult wards) and so most is soaked up by the sponge anyway. Often the ET tape obstructs the mouth so plenty ends up on the chin lol, and being inexperienced I'm really scared to squeeze anything in there that'd risk dislodging their tube. Sorry to go off topic, but speaking of this does anyone have any tips on good quality mouth care for really tiny ventilated babies?
Best of luck! I'm sure you'll love it. I just had my first week in NICU, and I've also got no previous experience. Although I can't be too helpful, one thing I can say is bring in a notebook to write things down in as you learn. I read mine back today and had forgotton a lot of what was said it me. And bring in a pocket calculator. I'm so glad to have had mine with me.
What a super topic. As an adult nurse due to start in NICU, literally the only thing I feel confident in is being able to care for the adults in the unit. I hope when I'm overwhelmed with all the learning and adapting that I don't lose sight of the care and attention the family needs.
Excellent! Congratulations and very well done you.
Good Luck for tomorrow!
Thanks Raye! I'll add Bliss to my reading list. Are the current levels of care 1:2 hd and 1:4 sc, or is this a new aim? Will this mean less staff or more staff per infant?
The unit I'm applying to is Level 2 and Level 3. It's a specialist centre and it has medical and surgical level 3. I'm not sure if I'll be based in a particular unit, or if staff rotate. But anything with 'neonatal' above the door will be just fine with me.
Thank you for your advice It's so great that nicu welcome adult nurses.
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