What are your parameters for resusitation at delivery?

KRVRN, BSN, RN · Jul 27, 2002

I investigated and the dopamine was given via a UVC and they removed the UAC d/t the cath toes. The fingers were turning black at the same time as the toes. The necrosis has continued up her fingers and is starting to threaten the hand and she's only on a renal dose of dopamine. Poor little thing also has a gray tummy, not good...

prmenrs, RN · Jul 28, 2002

KRV--I wonder if she threw a clot? It's just not making sense.

nell · Jul 28, 2002

Do y'all verify line placement by x-ray? I've never been anywhere where we didn't. Always pull back the line to an appropriate place (or remove and possibly replace if it's totally in the wrong direction).

prmenrs: I hope you're still going to mentor us here even tho you're retired! I'd never heard of "cath back" either, but that makes sense since we need to assess buttocks, feet and toes for cyanosis, blanching or edema. I'll start looking higher now.

That is so wonderful that you are continuing caring for little ones as a cuddler!

NicuGal, MSN, RN · Jul 29, 2002

I have seen one kid with dusky finger tips with a line that was placed high. Once it was pulled back, the fingers were pink. But it sounds like a clot was thrown or something else happened. If the Dopa was going peripherally, then yes, but usually thru a line you are safe. Was the Dopa made correctly? That happened once where straight Dopa was given, not mixed and the kid lost a limb.

KRVRN, BSN, RN · Jul 31, 2002

After further checking I believe the baby was on quite high doses of dopamine initially, then was weaned to a renal dose. The duskiness and necrosis began during that time and hasn't really gotten worse. My guess would be that it was poor perfusion d/t the pressors. ??? Line placement was verified by x-ray. The 4 fingers on the right hand are completely black and shriveled now. The tips of a few toes too.

dawngloves, BSN, RN · Jul 31, 2002

I have seen cath fingers.The tips were black and the docs were like, "Did you get ink on them?" If I remember correctly it was the UV that needed to be pulled back. Interesting therory about the Dopamine. This kid was way up there on the dosage, definately not renal.

NiteNICUNurse, BSN, RN · Jul 31, 2002

Our neos will resusictate up to a 22 weeker....the parents are counseled before delivery of the possible outcome and are given options. Usually if the baby comes out with some resp effort/heart rate we will intubate and admit. 2 years ago we had a 22 2/7 weeker (IVF, dates were correct!) 490 grams but dropped down to 420g. She came for a visit last week no brain problems, no O2....just a happy, smiling small toddler.