by BabyLady

I started post graduation working my first job as a nurse in the NICU...needless to say, I have a huge learning curve.

Now, I understand the leads that go on these little ones sometimes gives false readings based on how active the infant is, etc.

However, if I take care of a baby for a couple of days....for example, let's say has no signs of bradycardia...and then on the third day....I spend several times during that day turning the alarm off for brady's...double check the leads, even CHANGE the leads...same thing.

My perceptor, a 14 year veteran of the NICU, tells me not to worry about it.

However, I'm thinking..."Well, at WHAT point do you get concerned about it?????"

My perceptor is a little touchy...it's hard to ask her questions because she generally seems irritated in her answers.

Re: New NICU Nurse....have a weird question

When the monitor alarms bradycardia, what does the tracing on the screen look like? If you are seeing "artifact" rather than a true EKG tracing with excess space between the peaks (which would indicate a slow HR), then it may be reasonable to assume that the monitor is not telling the truth. Artifact can indicate that the leads are not in good contact with the baby's skin possibly due to poor placement of the leads, the leads being old and dried out, or excessive movement of the baby during a crying spell. In this situation, you can verify the HR by reading your pulse-ox monitor (if one is in use) or by quietly slipping a stethoscope on the baby's chest or back. You may not be able to get an accurate HR this way, but you can tell whether the baby's heart is racing, or whether the beats are very slow and spaced out. Also, it is usually pretty safe to assume that if the baby is kicking and screaming, then it's not bradycardic (Choking is a different story, but the baby would not be screaming if it is choking.)

If you are using a small, portable monitor without a screen, then you won't have an EKG tracing to look at and evaluate. In that case, it is even more important that the leads be properly placed and fresh so that you do get accurate HR information. When you do your initial assessment on the baby early in your shift, check the integrity of the leads and wet them down or change them, if necessary. Most leads used in NICUs now are the gel-type that are very gentle on the baby's skin, so changing them isn't traumatic. Never tape over a loose lead, as that is far more damaging to the baby's skin than simply changing them. Also, by eliminating false alarms, you are providing a much quieter, more calm environment for all of the babies in the area, and saving yourself lots of wasted time respondng to useless alarms.

Good to "hear" from you. Hope you're enjoying your new job!

Re: New NICU Nurse....have a weird question

Also, depending on the size and gestational age of the baby, he may just have a low resting heart rate, which the monitor recognizes as brady and alarms. Some full-term babies have resting heart rates in the high 80s, low 90s.

Re: New NICU Nurse....have a weird question

Well I would check my waveform for wide complexes and verify it by looking at the heart rate from the pulse ox reading too. If you still have doubts then change the leads. Does the baby desat or have any color change with the brady? How many weeks is the baby? Sometimes they have more bradys during/after feeing. In report ask the off going nurse if they also noticed increased bradys or check back in their notes. Do you feel comfortable with your preceptor? If you feel that you can't ask her qestions or that she is annoyed by you then maybe they can put you with someone else. These babies are you highest concern not your preceptors feelings. No one know's everything and because you just graduated there may be new things that you know more about than she does. You are allowed to have your own nursing judgement and she needs to respect that.

Re: New NICU Nurse....have a weird question

I usually look at the complexes too, to see how far apart they are.

I have a question about using the heart rate on the sat probe. The way the sat probe works is that it measures how dark the blood is and correlates that with a number which is shown as the 02 sat. This takes a few seconds, so there is a lag in the timing on the sat probe. If your pt bradys and you look and the monitor and compare, the number for the leads is in real time, and the number from the sat probe is a few seconds behind.

I'm not sure what monitors you use, but we have Phillips monitors. If I am not sure if a brady is 'real' then I change my screen to the choice that says "Oxy CRG.' In this mode, you get a readout on your screen of the past few minutes. You can see the dips in heart rate and see if there was an apnea or shallow respirations and see if there was a dip in the 02 sat.

I am sorry that your preceptor is touchy. I understand what a sticky situation you are in, I wonder if there is a way to get a different preceptor so that you have optimal learning.