by HurleyRN

Just another thread to pick everyones brain..
We have recently had some issues with parents on the unit complaining that the nurses will not let them hold their babies.
The RN has explained each time that the baby is too unstable, too small, temp unstable and in some cases has umbilical lines. In one case, we were told by nursing office that we HAD to take the baby out for the parents to hold. Alot of us felt that this was taking "family centered care" too far! We are in a critical care unit and I feel that we have an obligation to the patient, first and foremost to promote a safe environment. I really felt that management had no place over-riding our nursing judgement and especially not backing us with the parent. It did not look very professional in my opinion. Back to the original point... I would like to know what the policies are at different facilities about taking babies out with lines. We all know how touchy they are. Our policy has now changed saying that we CAN take them out. I feel like it goes against common sense. If a baby is that small and that sick, they should have as litle stimulation as possible to prevent bleeds, loss of temp, etc, etc.
I also am surprised that any parent would demand to hold their baby when they are clearly sick or small enough to be in our unit. As a parent, I want what is best for my child!

Re: Holding with UAC/UVC lines

Sadly a lot of parents have a hard time separating what is best for them, and what is best for their baby. It's hard for them to understand that there are times where holding their baby really isn't what's best for the baby. Anyway...

Our policy states that it is up to the nurse's digression at the time. It depends on the overall status of the baby at the time (are they having a "good day"), their temperature, are they gaining good weight... all of that stuff. For kangaroo care - babies that are <1000g / not gaining good weight will only kangaroo every other day (sometimes every 2 days...).

The key to it all is being consistent. We stress early on to every parent that there will be times where they're not allowed to hold their baby - that's just how it works.

We also do not allow holding / kangaroo care with umbical lines in place. (if you do a thread search, you should find a few on this topic!). We will make some rare exceptions to this one. Usually when it's a term kid who just needs the line for glucose / antibiotics... We make sure that the line is super secured, and we make sure that the parents are never the ones to get the baby to and from the bed. The nurse always picks up the baby and transfers to Mom. We do this, mainly so they can still breast feed.

Hope this helps!

Re: Holding with UAC/UVC lines

Thanks! It does help! I think everyone on the unit is more than happy to encourage kangaroo care, but like you said, when appropriate. I do find myself, however, feeling that the micropreemie, or kids with bleeds are better off with minimal stimulation. Even if haing a "good" day, I wonder if we are risking too much and potentially setting them up for a "bad" day.
I was surprised to hear that you guys do umbilical lines for term kids. Generally we try to avoid them unless its for the bitty ones that are on vents and needing pressors. We try to get PICC's in them ASAP.

Re: Holding with UAC/UVC lines

Our policy regarding UAC/UVC is that we (the nurses) have to ask the doctor the first time. If they have been up once usually all restrictions are gone. Right now one of the staff is holding one of the babies with UAV and UVC trying to keep the baby calm (and accept the CPAP).

I have never seen a UAC/UVC pulled by accident and here parents usually do the lifting themself!

All research shows that babies (including <1000g) do well from KMC. For example they usually have a better weightgain and their sleep is more normal (compared with the incubator). We take micropreemies (<25 weeks) out to their parents several times a day and we have good results in Sweden. It´s considered a medical treatment and the more instable and sicker baby the moore important we think it is!

Anna

Re: Holding with UAC/UVC lines

The presence of umbilical lines does not in itself have bearing on whether a baby can be held in our unit. Generally umbilical lines our access of choice in both preemies and terms requiring Level III care. As soon as we think the infant is medically stable enough to tolerate the transfer, we encourage kangaroo care (although not several times a day as the transfer process seems to be fairly stressful for many micros). On the other hands, umbilical lines obviously don't last forever, so some micros aren't ready for coming out before their umbilical lines are out. But Sweden is really right that evidence does not support restricting kangaroo care based on size, weight gain, etc. I just wish that transferring them in and out of the isolette didn't require so much negative stimulation!

Re: Holding with UAC/UVC lines

Yeah...having a UAC, UVC, broviac, or PICC line by itself doesn't prevent a parent from holding their baby in our unit.

It's about whether or not the patient is clinically stable.

Case in point: I recently took care of a full-term infant on RA who was on phenoarb for seizures, was working up with feeds with TPN/IL in a UVC. Am I really going to tell Mom she can't hold her baby?

Most parents I've been with are hypersensitive to the fact that the baby has lines everywhere and won't even pick them up without asking unless they've been here forever. In any case, I'm in the room most of the time when they first get to see their baby so I can start that conversation, of having me hand them off to the parent and how the IV line is waaaaaay more important than the EKG/sat probes coming off.

Re: Holding with UAC/UVC lines

No way. Not with a UA or PIA. If you have one on our unit, you are pretty darn sick and/or unstable.
A UV is not a problem for me, but some nurses on my unit refuse.

Re: Holding with UAC/UVC lines

I agree that it needs to be evaluated on how each baby is doing, but I was particularly interested in the umbilical line issue due to the fact that they can migrate and perf....

Re: Holding with UAC/UVC lines

Thanks for bringing up this topic. We do not have any policy specifically addressing holding a pt with uac/uvc lines. I brought this up to several different co-workers and the consensus is that it depends on the clinical stability of the pt, how the lines are secured, and the amount of "attachments" the pt has i.e. vent/multiple lines, etc. The unit I work in is very family centered and tries to incorporate as much parental bonding as possible.

Re: Holding with UAC/UVC lines

UA's I won't, but UV's don't bother me if the kid is stable.