Trying to revise a policy

[LOVEnicuRN]

Hey Ladies & Gents!

I work in a 70-some bed NICU, Level III. We do basically everything here including ECMO, although I do not work with that critical of kiddos. However, I have worked with my fair share of 26 weekers and up and those kiddos are why I am trying to revise one of our policies.

As you all know, these kiddos are at a high risk of developing intraventricular hemorrhages. We have a handy developmental care chart that helps us know what we should and shouldn't do with these kiddos and older babes as well.

The part of this chart/policy that I am focusing on is the position in which these babies should be, as far as head positioning, elevation of HOB, and how we do our cares.

Currently, for any kiddo born 28 weeks and younger, they are to be flat (HOB) and midline (chin lining up with umbilicus) for the first two weeks of life. These are obviously done as a preventative measure against IVH.

However, many nurses, nurse practitioners, and even doctors, believe that this 'flat and midline' means HOB flat, head midline, and supine.

Myself and other nurses have issues with this misunderstanding, since it can greatly affect our babes. For example, I had a 28 weeker (born at 26 weeks) who was having feeding/residual issues. He had been supine consistently. I log rolled him and placed him on his right side, still midline, to help with digestion.

I know some of the nurse practitioners are unsure as to what is correct, and I know some nurses who believe that the baby can be on its side and midline but refuse to do it because they're afraid they'll get in trouble.

So what I am trying to do is research what is best for baby. Supine or turnable? HOB flat or elevated? I also want to add really clustering cares, limiting suctioning as much as possible, and not elevating their lower half with diaper changes.

I have found some information but not a lot. I've only been looking at 2009 and newer research. Can I go earlier? What is your NICUs policy?

I've seen powerpoints from other NICUs and EBP projects which are usually really helpful but I've only found 2 of those.

So if you can help me with this, that would be awesome! I'm ready for this post to be lit up with information!!

[NicuGal, MSN, RN]

Our small baby protocol calls for head midline for 72 hours. We elevate the HOB 30 degrees for our VAP protocol on all intubated kids.! Midline refers means head is not turned while on their back, they can go side to side as lond as the carotid a are not occluded.

[LOVEnicuRN]

Exactly. So now I'm just trying to find reaserch/info to back this up so there can be a consensus among the unit..