your admission routine

[tinybbynurse]

hello there! I've been in NICU for about a year. I haven't tended to get a lot of admissions, though - so it's still kind of a skill I'm getting down. The year kind of flew by but now I know I should probably just ask for more admissions. In addition to simply asking for more admits - what is your typical routine for admitting? Sometimes I get a little overwhelmed - should I start the IV first? Get the labs? What if I need to get a peripheral draw for a bacteria culture?! Which should I do first because sometimes IV starts can take a while and sometimes it's done on a first try. Obviously we want to send those labs/type&coombs and culture if it wasn't already drawn ...and sometimes I know you can get the blood for the culture AND labs off of the peripheral stick but ALSO sometimes you can't draw off enough blood for everything, either. And again, like with the IV sticks, same with peripheral sticks ... sometimes you get it fast, sometimes you don't. And of course I am still continually building on my sticking skills, whereas some people are super pros and save a lot of time because theyre really good at it most of the time. I consider myself alright, but I can def see sticks taking me more time than say a more experienced person, and that can really drag out the admit process. And one thing that def makes me nervous is when the baby's chem is low ... obviously getting an IV and starting fluids is important, but that IV stick, like I said, could take 5 minutes or an hour and 4 people to get ...and then I haven't sent my labs at that point if all I'm doing is focusing on the IV stick....see where my brain is a little haywire? I know everything I need to do, just not always sure what order to do things depending on the baby.

And you want VS.... Vit K / erythromycin administration ...sometimes there's other random orders...or RT is also trying to set up....and often admissions seem to be scrambled and chaotic, even when I watch others do them. I just want to know what are some kind of routines/basic guidelines you guys go by when admitting to kind of keep you on track, organized, and get things done efficiently even when it is a little chaotic?

PS. we do have admit brainsheets available. They help in terms of providing somewhere to write down info but don't actually help me with what order I should do things.

Thanks!!

[itsybitsy]

- Get respiratory support initiated.

- Get your initial vitals and a quick assessment.

- Get labs drawn, as they need to be drawn before any initiation of fluids. As you said, a blood culture needs to be obtained by sterile venous draw, and you can get all other labs, if able, with the same blood draw. Or if starting lines, blood can be drawn from the umbilical lines, which would kill 2 birds with 1 stone. Or get all other labs, other then the blood culture, from a capillary stick. If a blood culture is your difficulty, you might start the PIV, after getting other labs from a capillary stick, if labs are critical, as in a low blood sugar, and get the culture after. This is not ideal as antibiotics should be started within an hour of birth if it is a suspected chorioamnioitis, but you'll need to prioritize based on the baby.

- If no lines are started, then start the PIV. If it's a difficult stick and someone else needs to try, move on to the next step when you get a few minutes between tries.

- Get your meds - erythromycin, vitamin K, antibiotics, etc. If others are looking for PIV sites, go ahead and give the erythromycin and vitamin K. All other meds will then be set to go once the PIV is in and cultures are drawn.

Ideally, that would all be done in 30 minutes to an hour.