Admission criteria

  1. I work at a teaching hospital where usually we only have residents at night (unless by the grace of God we get an NP for a night) so as you can imagine it can be quite scary when you're stuck with someone who doesn't know their head from...well...you know. The other night (same as my last post) this idiot resident comes up from a delivery with a 224 gram fetus. Yes, 224grams. Exactly 8 oz. An abortion, I would think????? 14-15 weeks. She said it had a HR. It didn't when it got to us. Although it did "gasp" or something about 15 minutes later and got a HR of about 40 for a few minutes....very weird....Anyway, by her bringing it upstairs to us, we have to admit it--which is an enormous charge. We argued back and forth with L&D for at least an hour until they finally agreed to take it back (much cheaper for the family...who I'm sure won't be paying anyway....) What's your protocol for stuff like this? Granted we usually have to bring a lot of "really not viables" up b/c in the past residents have labeled some that when an hour later they were still gasping in the sink and had to be tubed, but this was ridiculous!!!
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  2. 14 Comments

  3. by   dawngloves
    Man! You gotta get a policy and fast! Off the top of my head, we don't bring anything <23 weeks and 500g near our NICU! Cripes! What was she going to tube it with???? Yeah it had a heart rate! So does a 6 week fetus!
  4. by   NicuGal
    Ours is over 22 weeks and 500gms. I would have refused that one. That was ridiculous. Please tell me that you let the resident have it...and the OB staff for letting him take that baby!

    I would have said...here, let me take my Bic pen apart and you can intubate with the inside of it...what an idiot!
  5. by   Heather333
    Ours is 24 weeks but no weigh limit. We had a 450g 27-week IUGR that did fine and went home.

    Heather
  6. by   NICU_Nurse
    I checked this morning at work- our admission policy is 22 5/7 weeks with no weight requirement. We have had some smaller babies...18 weeks, I think?...that were admitted to Level II, but they were comfort measures only. NO interventions on anything smaller than 22 5/7. It's sad, really, because it's a fine line to walk but it seems that more often than not no one considers the long-term outcomes of resuscitating these tiny babies. We were just talking about that last night. Down here, there is an abortion clinic that does procedures up to the 25th week. 25 weeks! We admit MUCH younger babies than that- there's a world of difference between a 23 weeker and a 25 weeker, you know? Just interesting to see how the rules are different depending on where you go.
  7. by   dawngloves
    Here's a question; What if you had refused to help that doctor? What would the ramifications of that be? If I went to a delivery and a 300g 20 weeker came out and the doc asked me to assist with intubation, could I just back up and say, "No way!" ?
  8. by   KaroSnowQueen
    IttyBitty, I was upset by the visual image of babies "gasping in the sink." Are these miscarried babies? Shouldn't they be with their parents as they die? Or at least in a basket with comfort measures?
    As the nurse grandmother of an 18 weeker who recently died, I fully understand the futility of resuscitation of a tiny baby that size, and the plethora of handicaps many small babies have if they are "successfully" saved, and feel as many of you do that tiny ones should be allowed to pass with dignity into the next world.
    However, why on earth don't these residents leave these babies with the parents with comfort measures?
  9. by   karenelizabeth
    We resusitate from 24 weeks and intubate and admit if the baby gasps from 22 weeks. Although personally having delivered a 19 weeker at 300g I find these little ones really hard I wouldnt have wanted my daughter to go through this and yes she gasped. We have no weight limit our smallest surviver was a 410g 25 weeker who is now 8 and an absolute beauty
  10. by   NicuGal
    I just found out that they have lifted the weight issue. We used to get the ones that were less than 500gm if they were IUGR, etc. Now, it is anything goes in the weight dept.
  11. by   dawngloves
    We use weight as a critera because of equipment. Terribly traumatic to intubate a 450g neonate. We had a 26 week IUGR, 450ish, that we just could not get a 2.0 in. We put her on CPAP and parents made her DNR. She hung on for a day. So sad.
  12. by   nicudaynurse
    A NICU I worked in had a 26 weeker IUGR that weighed 14 ozs. She survived, but had a pretty rocky NICU stay. She was discharged after 9 months. She is now 6 and does have some disabilities, but is a very happy child and has the best family ever!!

    This NICU pretty much saved 24 weeks or more, but occasionally we did have 22 or 23 weekers. Sometimes it depended on what doctor was on as to how aggressive the treatment was. It also depended on how aggressive the parents wanted us to be. If they said "save my baby" then we did.
  13. by   NicuGal
    We had an IUGR that was 25 weeks and weighed 400 grams...went down to 350gm! She survived, but I can't say that it was for the best.
  14. by   IttyBittyBabyRN
    Guess I should have been more clear. We did not do anything for the 224 grammer. The issue was that the Dr. brought it up to our unit which requires us to go through the "admission" process thus creating a chart, charges, etc. I am convinced that med school is in no way preparing docs for the huge financial responsibility they must now consider in such situations.

    As far as the gasping in the sink, I have heard many stories about years past that involved residents deciding at delivery that the babies weren't viable, then an hour later they're still hanging on. That led to the rule that anything with a heart rate should be brought to the unit.........back to the original issue.....shouldn't there be some level of common sense involved????? Shouldn't a third year resident have some grasp on the "big picture" and have known to wait a few minutes until the "abortion" ceased to beat??? It is so frustrating that these people are not smart enough to know when it's time to CALL THE NURSES AND ASK WHAT TO DO!!!!!!!!

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