katierobin23 3,570 Views
Joined Dec 31, '12.
Posts: 150 (44% Liked)
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.
BUN 300. Alive and hopefully will stay that way, this is a patient in my PICU right now. Was down to 89 when I left this morning... 25 kg kid [emoji15]
If a baby is having feeding issues and has an NG (even a term kid), I want to know what's in the stomach before I start, even if the baby is going to nipple. If he doesn't feed well, was it because he still had a bunch of milk in there from three hours ago? We don't know at that point. You can't check a residual after he nipples so you run the risk of over stuffing him by putting the remainder down the tube if he doesn't take it all. (Which I understand didn't happen this time but it could have.)
You're correct that placement wasn't an issue in this case, but residual is a little different.
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!
We just started using the Medelas, but our policy is to only change the liners when soiled or torn. Has any research been done to justify changing more frequently? Very curious to see if we're in the wrong! Each liner is labeled with a patient label and stored in a biohazard bag either next to the warmer or in the baby's bed. We have one warmer per room, but some of our rooms are semi-private so there is some sharing sometimes between two babies...which makes me a little uncomfortable, but the theory is with good hygiene between babies it shouldn't be an issue.
Interesting to hear about what other units do
We never even covered it. Very similar to what OP said, we were told that we would be trained on the job. I think it may have something to do with the location of the school...I went to nursing school in the northeast but then moved to NC for my first job. No school around us that we knew of did IV training, but when I got down here my coworkers could not believe I hadn't done it in school. Thankfully I started in the NICU so my preceptor expected to teach me how to specifically start IVs on babies, but she was taken aback that I had never stuck a person before...hadn't even stuck a fake arm.
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!
We have Angel Eye cameras, they're still new so I can't speak to long term use issues but so far it hasn't been a problem. We were worried about the increased call volume but honestly, I think we've seen a decrease. I personally haven't fielded any calls about fixing the camera or that the baby is crying. We make a point to tell the parents when we set it up that this is a learning curve and it may not always be perfect. Also that babies cry and this is an intensive care unit, we may not be able to get there immediately and that's okay. We also let them know very clearly that this is a privilege...we can shut the camera off any time we want to and if they drive us crazy with it, then we reserve the right to take it away...in a nice way of course
But I think it's a wonderful thing, the parents love it. If I had a baby in the hospital I would love it too. I write little notes and leave them in the view saying how much the baby weighs, or how much he/she ate, or just any little love note and sign it from the baby, it's all about attitude and I have fun with it
Very similar to NicuGal, we give a dose of fentanyl before intubation if it's not an emergent situation. Most kids on conventional ventilators don't get pain control, we use non-pharmacologic methods instead and most do just fine. Babies on a jet sometimes get a fentanyl gtt if they need it, but we try to stay away from it if possible. Versed gtts are fairly rare, but we do bolus some if the fentanyl isn't cutting it.
We swab nares of every baby on admission and every 2 weeks. Any baby that comes up positive is on contact precautions until discharge. Any baby whose mom was positive is also on contact until discharge, regardless of the baby's actual status.
We continue to feed if the feeds are 50ml/kg/day or less. Any more than that and they are NPO for 3 hours before and 8 hours after. We run blood over 3 hours, so the kid ends up on fluids (clears if they aren't already running tpn/il) for the better part of a day. I haven't appreciated any sugar issues with this, we just check dex sticks per regular protocol.
We used to restart feeds at a low volume and work back up, but have recently began restarting at full feeds and we haven't seen a problem with that. I would love to see more of the research for this!
Regarding the Epogen, that's great that it seems to be working! We are in the middle of a blind trial right now to see if we are going to initiate an Epo protocol or not. We use it currently only for babies whose parents are Johovah's Witnesses.
I like the comment in the video
that the baby was "in a fetal position!" Uh...you know where that term comes from, right?
Following! I'm really curious too
We have a policy that says we can choose not to use leads on micropreemies with significant skin integrity issues. Those babies almost always have a UAC which we use in conjunction with the pulse ox to monitor their heart rate until the skin matures enough to use leads.
In my experience, coban is much more abrasive to skin than the pulse ox sensor, we cover it with clear tegaderm to keep the adhesive off the skin, and wrap it gently with a posey wrap.
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