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karnicurnc, MSN, APRN, CNS 3,165 Views

Joined Oct 20, '09 - from 'Virginia'. karnicurnc is a Neonatal Clinical Nurse Specialist. She has '17' year(s) of experience and specializes in 'L/D 4 yrs & Level 3 NICU 14 yrs'. Posts: 169 (30% Liked) Likes: 76

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  • Jan 12

    We only do MRSA swabs in a couple situations -- babies born to mothers with a history of MRSA and babies coming to our unit from other hospitals (we send out for certain procedures and also accept patients from surrounding facilities). All of these patients are placed on contact isolation until they have been cleared. And of course we'll culture any suspected infection.

  • Jan 12

    We used a graduate cylinder of warm/hot water for warming for years. Then our unit had an outbreak of Klebsiella with some pretty serious outcomes. Out went the graduate cylinders, any tap water on infant's faces and one time use of bath tubs. No source of the Klebsiella was ever found in spite of culturing anything that would stand still including every water source.

    For the longest we had milk warmer cabinets but those were shared areas and there were some near misses in administering wrong milk that had been left in there. So for the longest, we had nothing. I repeat. . . nothing. If the kid was in a giraffe, we could stick the milk in there, otherwise, we had to remember to set the milk out 30-60 minutes before the feed and hope we achieved room temperature by the time we fed. Seriously.

    We initially got 12 waterless medela warmers, so approximately 1 for every 6-10 kids. Of course every kid had their own warmer bag and coming from a time when we had to remember to take milk out 30-60 minutes early, it was not difficult to coordinate our warming times.

    Now every kid has a warmer. We also have evaluated the changing of the bags every day as we did at the beginning (and it took about a year to educate our secretarial staff how to order enough warmer bags for the unit, we were constantly out). There was an article in "Advances in Neonatal Care" about frequency of changing the bags. It was a simple study, where cultures were done of the bags. They found that unless visibly soiled, those bags were not growing anything for up to a week (not sure on the exact details, it's been a year or two). After review by our manager (and the potential to save a ton of money), we went to changing those bags once a week. No problems associated with that have been identified so far and we are a large unit (50+ beds) that strongly utilizes EBM and donor EBM.

  • Jan 4

    Old practice used to be to use O2 flow on skin to aide in drying site, with the theory to have oxygen act as a healing agent in terms of vasoconstriction. The problem with high level O2 (100%) is that it can potentially effect the eyes worsening or inducing retinopathy of prematurity. Oxygen is a great medication, but the more we learn about the effects we become more cautious on how liberal we are using it. I personally have found great luck in using prescribed ointment, however the key is to apply a layer of vaseline to the actual diaper so it is unable to wipe off all that precious ointment.

  • Jan 4

    I assume that you are using the flow to dry the perineum after cleansing? If so, I can’t imagine that the FiO2 matters. I did a brief Google search, and the only reference I was able to find was a Google Book site for The Great Ormond Street Hospital Manual of Children's Nursing Practices.

  • Dec 24 '15

    Quote from Dogen
    A 44 gauge needle would be incredibly tiny, since gauge and diameter are inversely related. A 34 gauge needle has an outer diameter of 0.1842mm. Compare that to a 7 gauge which is 4.572mm.

    That looks like a 3 gauge.
    I gave my vote to reindeer games. Twisted.

  • Dec 24 '15

    Some universities and colleges will offer a Spanish course for healthcare providers. Would you be interested in something like that? You could ask your instructor about NICU-specific words in addition to the general words/phrases that you would learn as part of the course.

  • Dec 24 '15

    Maybe hot chocolate or tea? Good luck!

  • Dec 24 '15

    Quote from caliotter3
    Maybe hot chocolate or tea? Good luck!
    I could go for the Hot Chocolate

    I called, they said apply, so I did. Only time will tell... Now hurry up and wait!

    Annie

  • Dec 24 '15

    I would be on the phone with HR as soon as my eyes were open...and at least a cup of coffee drank! Good luck!

  • Dec 24 '15

    So I left my permanent staff nurse position to become a traveling NICU nurse earlier this year. My 1st assignment is in the northeast and it SUCKS. I get nothing but feeders and growers and get treated like I dont know anything. I even had a nurse recheck my kids temp when I mentioned he said was cold. ARE YOU KIDDING ME?! Needless to say I am absolutely not extending my contract here. My reason for traveling is to learn more. Thats not happening here. I am reaching out to fellow NICU travelers and perm staff to give me feedback and guidance as to what facilities you work in that allow travelers to take real ICU assignments. I dont need to take the kid whose coding every shift but I would like to increase my skills, if not atleast maintain them. I worked in a level 3 NICU for 3 years and have done jets, oscillators, nitric, cpap, high risk deliveries, micro preemie care, etc. Any feedback would be GREATLY appreciated!! Thanks guys! Also if you guys can recommend any recruiters and agencies you were happy with, that would be awesome. I took this assignment with AMN which sucks, my next assignment is at UMMC in Baltimore through TNAA. The recruiter is nice but a bit salesy. Thanks for the advice and help!

  • Dec 24 '15

    Our hospital policy is to close to sibs only when they get flu and RSV cases coming into the clinics or admitted to the floors. Flawed idea, but that is what the uppers decided.

    We only closed to other visitors when there has been an "epidemic" like H1N1.

    I get so tired of policing people and their illnesses.

  • Dec 24 '15

    @aerorunner---oh, dear. Do you have an Infection Control Practitioner? Can you use that resource?

  • Dec 24 '15

    Quote from prmenrs
    If some baby gets a virus and dies (not an unlikely scenario), bring on the lawyers. Not a good thing. Check w/other units in town; what are they doing? If they are closing for flu season, you can cite community standard. Especially if the local Childrens' Hospital is closing.

    This is a risk management issue, not a public relations issue. Administration needs to understand this. (Good luck w/that, btw)
    The problem is that we are the local children's hospital. Smh.

  • Dec 24 '15

    Ours hasn't closed to siblings yet this year either! It's horrible because families keep bringing their coughing and sneezing young children and get super nasty when we tell them that no one sick is allowed in! Bring on the respiratory screens every time a baby starts to sound stuffy or look a little sick.

  • Dec 24 '15

    If some baby gets a virus and dies (not an unlikely scenario), bring on the lawyers. Not a good thing. Check w/other units in town; what are they doing? If they are closing for flu season, you can cite community standard. Especially if the local Childrens' Hospital is closing.

    This is a risk management issue, not a public relations issue. Administration needs to understand this. (Good luck w/that, btw)


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