my Biggest fear.....

ABQLNDRN · May 7, 2007

Ask your unit educator to start doing mock codes--we do that on my unit and it is very helpful. Much better to make a mistake on a dummy than a real person. We do both antepartum, postpartum, and newborn codes on my unit and it's very effective.

crissrn27, RN · May 7, 2007

Just try to remember your NRP stuff, maybe make cheat charts and post by the stabilet. Review your NRP often. What made me feel better when I was new was doing practice drills with our doll. Just remember PPV is the number 1 thing to help resuscitate a baby! I often see people continue to try to use just stimulation on a baby that needs PPV. After about 30 seconds stop stimulating and start PPV'ing. And don't be afraid to call for help if the strip looks crappy. Better to have the extra hands and not need them than to need and not have. I'll try to put it in simplified order for you, the steps you need to take.

1. Stimulate by rubbing with blanket, flicking feet, for no more than 30 secs, if no response move to #2

2. Check HR, breathing, color, tone, quickly. Start PPV if no breathing effort, or HR less than 100

3. After 30 secs, recheck HR, breathing effort, color and tone. If baby has improved breathing effort, HR above 100, improved color and tone, continue to give BB O2 and stimulate, monitor closely and withdraw O2 slowly to prevent secondary apnea. I usually will monitor for 10-15 min. and if baby is OK at this point and didn't need anything but 30 sec PPV I will allow baby to remain with mom. If it needs more than that I will take to nursery when baby is stable enough to go. If no improvement continue with PPV, start chest compressions if HR is below 60.

4. Continue the cycles of PPV and chest compressions in 30 sec. cycles (checking for HR, breathing effort, color and tone very quickly in between)until HR and breathing effort improve, after the first 1-2 min. you should have someone there able to intubate and give orders for drugs to improve HR, etc. Usually that isn't needed, and by the time the initial steps are taken you should have someone their that is able to continue into advanced NRP. I haven't taken the new NRP yet, but I do know one of the new recommendations is at least 2 people present during PPV. Also, the NRP guidelines are that someone that is NRP certified be present for every delivery who's ONLY responsibility is the baby (not baby and mom)

Hope I didn't miss anything, and that this helps you. After the first couple of babies you have that need PPV you will feel better, I sure did. It is amazing how fast newborns usually respond to PPV.

crawlyberry · May 7, 2007

Hi...student nurse here...What exactly is PPV?

crissrn27, RN · May 7, 2007

PPV=positive pressure ventilation, in other words, bagging

magz53 · May 7, 2007

You are a better nurse for having fear.........it is the nurse who has no fear and thinks she knows everything who is dangerous. Sometimes there is fair warning of a bad babe and intervention can help during labor.......positioning, pit off, O2 for Mom, IV fluids etc. Pull the neonatal crash cart nearby and have everything ready. We are in a rural hospital with no pediatrician or mid-level care providers. Technically the OB is in charge of the rescusitation should it become necessary, but we all know how that goes. We recently had a precipitous delivery of a 26 weeker 5 minutes after arrival on the floor with what she thought was gas pain. We successfully rescusitated what we thought initially was a fetal demise. We actually had to bag the babe until the team from the tertiary care center came to get it.........which turned out to be 2 hours due to other emergencies that night. It turned out that drills served us well that night as we did kick into automatic gear. It is also helpful after an emergency to go over with your peers what went well and what could have been done differently. The hardest part for me is documentation of the whole thing if you havent' called a code and don't have a "writer" when all hands are busy. We had a good outcome and so far the babe is doing well.

adoptionacres · May 7, 2007

I think one of the biggest things is communication: Clear, TRANSPARENTLY clear communication. Talk everything out loud. And make sure that you address the communication to a specific person and that there is an acknowledgement and response to that communication: i.e. Joan, get RT here. Joan: I am calling RT, RT is on their way. and so on... I believe this is called "closed loop communication"

babynurselsa, RN · May 7, 2007

See if you can't work with your nursery team for deliveries that aren't yours. Ask them to let you DO thenursing interventions with them standing by as back up. This way you can get past your discomfort with someone at your side to talk you through it.

You might even see if you could pull a few nursery shifts simply for the purpose of attending some high risk deliveries from the baby nurse side. This will increase your comfort level.

dawngloves, BSN, RN · May 7, 2007

I think mock codes are your best bet. But remember your ABCs and you'll be fine until the NICU team comes. Even if you just give PPV it's better than nothing, (which I have seen some OB nurses do which really freaks me out!)

mitchsmom · May 9, 2007

Do you have a nurse in the room for mom when you are the baby nurse? It usually makes me feel a little better that there is the other nurse in the room (who is usually one of the 20-30 year experience coworkers from my normal team)- whenever a baby needs a jump start we both kick into gear and work together. MD can take care of mom while mommy nurse is helping you, at least long enough for the cavalry to arrive should it get to that point.

This won't make you feel any better but I have found that most of my jump starters didn't really necessarily show signs on the strip before they came out... in my experience you can never tell, sometimes the scary strip babies are fine and vice versa (granted, in my little almost 1 year experience (and we are a small community hospital so we transfer all preemies unless they are coming too fast... that is a different story and I haven't done that yet but we would place more experienced people with a preemie in the first place)... but that's why I always absolutely have all my equipment at the ready for every delivery, at least I feel better knowing I won't have to look for something & I always check for it personally myself even if mom nurse says everything is there.

The mock code suggestion and to go around with your nursery/high risk delivery people are great suggestions (I wish I had that option!!!!!).

rnin02 · May 10, 2007

I just had my first baby that needed PPV last night...was truly a little scary. Fortunately, the L&D nurse came right over to help (and support my decisions for starting/stopping PPV, etc, it helps when someone's done it before and they say, yes, that's right). I think I could have done things better & faster maybe...but by the 5 min apgar baby was pink, crying, being a good baby! But those first 2 (or 3) mins were hard. And I keep thinking today, "i should have gone for PPV quicker, I should have done it like this, like that...", but I think that's normal. At least I hope so! For me personally, I'm just going to try to frequently review NRP, since we don't get babies like this very often (this is my first "bad" delivery in 8 months) and don't be afraid to ask for help.

33-weeker · May 12, 2007

I remember my first really bad baby. A term 7+ pounder stat section for uterine rupture. We weren't allowed to attend deliveries without the neo, but without going into the long story - I ended up in the OR and didn't feel leaving would be right thing to do for the patient. It was the wee hours of the morning and staffing was thin. I was even helping circulate the OR before the baby was out.

Anyhow... They handed me this totally blue/pale, totally limp baby. I really thought they had handed me a dead baby. I remember thinking to myself,

"They expect me to fix this!"

Then I thought, "Even if the baby is dead, you have to go through the motions." By then I was going through the NRP steps. I grabbed the base of the cord as I was stimulating and drying the baby. It was slow, but I felt a pulse. "Thank you, Lord. I have something to work with." Of course this all happened in a matter of seconds, but time seems to slow way down when you're in the middle of an adrenaline freakout.

We rescusitated that baby. Apgars were something like 1:3:7. She was off the vent later that day when I called to check on her. She went home not long after that.

I think mock codes are a good idea - especially if you are in a place that doesn't have full-out codes on a regular basis.