When to start CPAP vs. blow by 02 vs. PPV? - page 2
by LRC_RN 6,013 Views | 12 Comments
Hello all, I am new to the NICU and I just recently took my NRP and I feel as though I have an ok grasp of what to do when a baby is experiencing 100% apnea but I find myself getting confused when it comes to situations such as... Read More
- 1May 23, '12 by FlyingScotAre you just off orientation? If so maybe you need to have a talk with the unit educator about getting you more supervised experience feeding preemies. I'm not sure you grasp how serious an error you made not intervening for this child until she had sats in the 20's and a decreasing heartrate. It should never have happened as you described it. I'm sorry if I sound harsh but this episode needs to be burned into your memory. This isn't a matter of learning each infant's feeding idiosyncrasies. This is a matter of not recognizing an infant in distress and then not intervening properly. Once her sats started dropping below acceptable parameters the feeding should have stopped immediately. Because you are new and not sure what to do you should have asked for immediate help from one of your more experienced co-workers (nurse or RT) to guide you in the steps to take to stabilize the baby. You got yourself in a pickle and then tried to guess your way out of it. Guessing is never acceptable and you are very lucky that the outcome wasn't much worse. From what you have said my impression is that you are unable to handle an emergency situation on your own at this time. You need more supervision from the people who work with you not from an anonymous message board.
- 0May 29, '12 by HazelLPNYou said what her sats were, but what did she LOOK like and what was she DOING during that time she was dropping? I assume that you stopped PO once she started having problems? Did you just look at your monitor or did you look at the baby? Looking at your patient is MORE important than the monitor, IMHO, if you know what you are looking for.
Once she started satting down into the 80s repeately, its time to stop, don't make the poor dear run a marathon. Let her regroup, get her self together......she'll let you know what she's ready to try again or you might just need to tube the feed....but don't do it until she's ready. While she's regrouping, you're watching her very closely to see how well she is breathing, what her color is, how she's acting...and then look at your monitor. If she keeps dropping, stim her first and if she doesn't complain, then it time to grab the bag and give her what she's asking for by NOT crying. These little does really do have their own language that you will learn as you gain more experience.
Use this as a learning experience and make sure that if you need help, ask.
Best to you,
- 0May 29, '12 by prmenrsI have often fed babies w/their bag and mask in my lap, O2 running. Feeding in a side-lying position is a good idea, too. If your unit has access to an Occupational Therapist or Speech Therapist who has expertise in the area of infant feeding, perhaps the baby could be eval'd by him/her, and a written feeding plan developed.
It doesn't sound like this babe is ready to eat. I would also worry that s/he might be trying to get sick, i.e., septic or something.
It bears repeating: Never trust a premie!!
Best of luck to you! and the baby.