NICU flight nursing

[sunnysideup09]

For all the NICU flight nurses: what type of team do you use? Is it nurse/nurse, nurse/MD, nurse/EMT, etc?

Also is your standard of care for babies born in outlying hospitals different than at your institution? Reason I ask is that I attended a delivery for 27 3/7 weeks and I give the same standard of care that the baby would have received at my NICU....Intubated, Infasurf, UVC, UAC, TPN, lab work, xray. Some of my other flight team members said they would have personally foregone the UVC/UAC, lab works, TPN, and come back ASAP. I don't think the standard of care should be any less.

Christine, RNC, BSN

[Jolie, BSN]

I've never done flight nursing, but in the 2 units where I've worked, the teams consisted of RN/MD at one hospital, and RN/RT at the other.

I agree with your stabilization of the infant at the outlying hospital, including intubation, surfactant, lines, x-rays, and labs. Did you actually start the baby on TPN prior to transport? That's a new one to me. At our outlying hospitals, it would have taken FOREVER to get TPN mixed, so we would have gone with D10 and lytes for the time being.

If you are in an evvironment where the staff of the outlying hospital is able to assist with these procedures in a timely manner, it makes sense to me to do them prior to transport.

[sunnysideup09]

We bring TPN with us to the outlying hospital. It's already premixed so all we do is grab it and go.

Christine, RNC, BSN

I've never done flight nursing, but in the 2 units where I've worked, the teams consisted of RN/MD at one hospital, and RN/RT at the other.

I agree with your stabilization of the infant at the outlying hospital, including intubation, surfactant, lines, x-rays, and labs. Did you actually start the baby on TPN prior to transport? That's a new one to me. At our outlying hospitals, it would have taken FOREVER to get TPN mixed, so we would have gone with D10 and lytes for the time being.

If you are in an evvironment where the staff of the outlying hospital is able to assist with these procedures in a timely manner, it makes sense to me to do them prior to transport.

[Gompers, BSN, RN]

Whether it's umbilical lines or a peripheral IV - we always have SOME kind of IV access when doing transports. Especially if the kid is really sick - yeah, we want to get them to our unit ASAP, but those are exactly the ones you need IV access to in case they crump mid-trip.

I'm curious as to what other hospitals do regarding IV fluids. We don't start TPN or D10-Lytes until the baby is 12 hours old - which is the first time we check electrolytes. For the first 12 hours, babies under 1kg are on D5W, and over 1kg are on D10W. So when we go on transport, the baby is usually pretty newly born and we just use those bags. If the baby is a few days old, and say is on TPN or D10-Lytes, we'll use whatever bag the hospital has going on the baby already, then get our pharmacy to make a new bag as soon as we get back to the unit.

[sunnysideup09]

All babies at our hospital are started on TPN if 32 weeks, D10W is used.

Christine, RNC, BSN

Whether it's umbilical lines or a peripheral IV - we always have SOME kind of IV access when doing transports. Especially if the kid is really sick - yeah, we want to get them to our unit ASAP, but those are exactly the ones you need IV access to in case they crump mid-trip.

I'm curious as to what other hospitals do regarding IV fluids. We don't start TPN or D10-Lytes until the baby is 12 hours old - which is the first time we check electrolytes. For the first 12 hours, babies under 1kg are on D5W, and over 1kg are on D10W. So when we go on transport, the baby is usually pretty newly born and we just use those bags. If the baby is a few days old, and say is on TPN or D10-Lytes, we'll use whatever bag the hospital has going on the baby already, then get our pharmacy to make a new bag as soon as we get back to the unit.

[BittyBabyGrower, MSN, RN]

We fly with a NICU nurse, resp therapist, fellow and flight nurse.

We go and stabilize, put in lines if needed, start IVF, usually just D10 for the flight, if bloods haven't been drawn we will send the blood culture there and start antibiotics if necessary and we always give the first dose of surfactant before we go. We aren't there for very long....we tend to swoop and scoop. We always transport with IV access, no matter what the kid is.

If intubated, we will sedate for the flight to decrease the chance of extubation midflight (been there, done that, hated it).

[dawngloves, BSN, RN]

All our kiddos are in house. But I am wondering about the UA/UV also.Seems like alot of time to waste while they put the lines in and then wait for xrays to confirm placement. I'm just Monday morning quarterbacking but I'd prefer to start a perpherial line with some D10 and just roll to where I can really get down and dirty with interventions.

[BittyBabyGrower, MSN, RN]

We will put in lines if we need to send a stat ABG, we will place a UVC (you don't need confirmation of placement if you do it according to NRP standards) so that we don't waste time putting in an IV on a kid that is pretty compromised. A lot of the level 2's we pick up from already have lines in by time we get there, so we go with that. Also with the UAC, we will place it, draw blood and not get an xray to confirm until we are back home. We don't infuse on it for the transport, we just flush with hep saline prior to departure. It all depends on the kid as to what you actually do. Some kids take time to stabilize enough to toss in the isolette, say bye to mom and head out. Others, we just do a quick look, and take off after a goodbye to mom.