katierobin23 2,820 Views
Joined Dec 31, '12.
Posts: 150 (44% Liked)
Day two on orientation in the NICU (my first job as a nurse), I assessed an IV all morning and didn't see anything wrong with it. The site wasn't red or leaking....but the leg was swollen, badly. The baby was getting Hyperal and Lipids (TPN) which tears apart veins and tissue really bad...learned that quickly. I wasn't assessing the leg compared to the other one, so I saw a chunky baby leg and didn't think anything of it...but this was a premie with chicken legs. By the time it was caught, the baby lost most of the skin on the top of his foot and everyone who saw it said it was the worse they'd ever seen. My preceptor felt awful because she didn't check behind me and I was brand new...but I felt worse. It was horrible. It was probably only three hours worth of TPN that had infiltrated but it was so rough.
Now I watch my IVs like a HAWK! I'll pull it and restart it in a heartbeat if I don't like it!
Also, I've become a big advocate for putting in a PICC for long term TPN, which is standard protocol, but not always done in a timely manner.
Also, about starting IVs, I never learned about it in school..never did the fake arm thing. We were told our hospitals would want to train us themselves and/or would have an IV team to do them.
Being a PICU nurse, I've learned the harsh truth which is that some kids will die no matter how hard we try to save them. I'm so sorry you're going through this, but know that you did everything you could have done to help him.
This was a week I experienced not too long ago.
Night one: Decent shift, I don't remember the details...average night. Probably what most nurses think of when they think of working in the NICU. A few feeder/growers, maybe an IV or two.
Night two: I start with two babies, but the second one is given to another nurse two hours into my shift because baby #1 took a nose dive. The rest of the night was spent trying to make sure this 13 ounce baby was comfortable and mentally willing him to produce urine...any urine at all. He is so swollen that his skin is cracking and weeping. He is on 100% and maxed out on the jet, I have the code cart by his bedside. At 0600, he codes. Pulmonary hemorrhage worse than I've ever seen...blood shooting out of ET tube with every chest compression.
We lose him.
Mom says, "it's okay. I have eight more."
Night three (less than twelve hours later): My assignment is fine, but my friend has the baby next to me and needs my help. The baby is super sick (sudden overwhelming sepsis.) Had been doing beautifully the day before, but now is on 100% and maxed out on the jet. We code her five times in 12 hours, we give her just about everything in the book. The fifth time we code her, she doesn't come back, time of death called at 0700. Her mom falls onto the floor, yelling, dry heaving, and crying, "why god why? Why again?"
After that week, I had some time off and I very much needed it. This doesn't happen all the time, but it happens.
In my experience, nurses who come to work in the NICU that aren't passionate about it don't last long. It's not a place to work to avoid working somewhere else, it's a place to work because you can't imagine doing anything else, imho.
I work in NICU, one night I had the parents of a baby come in and the mom was really nasty at the bedside...to the dad and everyone else. Dad was really quiet but we knew there was a history of abuse there (from both parties, they just were toxic together and awful to one another).
About 15 minutes after they left, we heard from mother/baby that they went back to her room, where he shot her and then himself. Terrifying to know that he had just been in our unit with a gun. You just never know these days.
I can only imagine the horror of walking in on that scene. The nurse had to take a leave of absence.
We didn't use that room for a long time!
We try to limit popping the top, but it's not really a huge deal in most cases. If the baby's temp is stable enough, we can pop the top if we need a better angle or more room to accomplish a task. There is a radiant heat source when the top is up, so the babies really don't tend to get cold if it's only open briefly. If the bed is humidified, we leave the top down at all times except in emergencies.
Now, I will say that on admission little babies do get cold many times during line placement, but I feel like that has more to do with the lack of humidity than anything else and using a radiant warmer would likely have the same result.
We have a "golden hour" quality improvement initiative where the goal is to get all admission tasks finished within one hour of birth and get the bed closed as soon as possible...it's hit or miss whether it is accomplished or not.
I'm starting in the PICU at a large children's hospital on Monday and these cases are what scare me the most. I can only hope I am able to handle myself as you have.
^^Everything that they said! The best advice I can give is to be a sponge! Take advantage of every learning opportunity and ask questions. I've found NICU nurses tend to be eager to help out newbies as long as you're eager to learn. We are big advocates for the little people in our care, and part of that is teaching new people how to take good care of them
Best of luck and congratulations!
In my opinion, L&D will help you more. Mother/Baby is almost entirely healthy couplets, you'll need strong assessment skills to know when something is going wrong but for the most part your patients will be healthy.
L&D on the other hand, you'll see a wide range of deliveries... normal healthy babies to the sickest of the sick and everything in between. You also will get to see what the NICU team does for immediate stabilization of a sick baby. Good luck!
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