car seat challenge/test

klone, MSN, RN · Mar 14, 2011

We always perform corificeat challenges on babies less than 37 weeks' gestation. However, is the 90-120 minute timeframe you mentioned part of the 2009 guidelines? Because we certainly don't do it for that long. We do it for 30-60 minutes. If the parents claim the car trip would take less than 30 minutes, we do it for 30. The max we ever do it for is 60 minutes, though.

Interesting. I just looked at the study. You're right that it does recommend 90-120 minutes, or the length of the car trip "whichever is longer."

Apparently our unit is not doing it in accordance with AAP guidelines.

However, it does say that length of observation is "suggested". I think one could argue that staffing does not allow for a 2-hour corificeat challenge at most facilities.

NicuGal, MSN, RN · Mar 14, 2011

We do ours for an hour unless the car ride is longer, then we take it up to 90-120 minutes. We don't have much of a problem since we are in pods and always in eyeball view of the kid or they get done with the sleep study if ordered. But I could see how that could be a problem if you are in a private room...you'd have to just do monitor signs I guess.

BabyLady, BSN, RN · Mar 15, 2011

Both our NICU and NBN do these car seat challenges WITHOUT exception and regardless of staffing issues in full accordance to guidelines.

The purpose is to make sure the infant can tolerate the ride home safely. The infant just has to be within eyesight of staff..the staff doesn't have to stop what they are doing in order to complete the test.

Elvish, BSN, DNP, RN, NP · Mar 15, 2011

We do it on everyone under 37 weeks OR who weighs under 2500g at birth, even if they are term (though sometimes the peds will cancel it in that case). We do it for 60min as well, unless the car ride is going to be longer. We don't stop what we are doing either. We just hook the kid up, he's in a place where he's in full view, and he's hooked to the monitor, so if something funky happens we'll hear the alarm. There are times when it's truly so crazy we can't do it, but in that case we pass it on to the next shift (and vice versa).

hikernurse · Mar 15, 2011

Our unit follows the AAP guidelines without exception. We do car seat trials on all our patients, even the full-term ones. The nurse assigned to the patient is the one who does the trial as part of the baby's stay. We are always in sight of the baby, though, so whether the baby is in a crib or the car seat, it doesn't change anything.

Our bigger challenge is ensuring parents bring in the car seat before the last minute. It's a treat to see parents walk through the doors with a car seat in their hands, they're always grinning because they know they are close to going ____ (shhh, I can't even say the word, I don't want to jinx anything )

klone, MSN, RN · Mar 15, 2011

Our unit follows the AAP guidelines without exception. We do car seat trials on all our patients, even the full-term ones. The nurse assigned to the patient is the one who does the trial as part of the baby's stay. We are always in sight of the baby, though, so whether the baby is in a crib or the car seat, it doesn't change anything.
Our bigger challenge is ensuring parents bring in the car seat before the last minute. It's a treat to see parents walk through the doors with a car seat in their hands, they're always grinning because they know they are close to going ____ (shhh, I can't even say the word, I don't want to jinx anything )

So what do you do for those parents who don't use a "bucket" type corificeat for their infant, but instead use a convertible corificeat? Do you require them to lug that whole thing up to your unit (which would mean uninstalling the corificeat, that may have been previously professionally installed)?

Elvish, BSN, DNP, RN, NP · Mar 15, 2011

So what do you do for those parents who don't use a "bucket" type corificeat for their infant, but instead use a convertible corificeat? Do you require them to lug that whole thing up to your unit (which would mean uninstalling the corificeat, that may have been previously professionally installed)?

We test the baby in the corificeat the family will be using upon d/c, which means we test them in the convertible one if that's what they've bought. It's a pain for them to bring up, and a little of a pain to hook baby into, but to do it any other way would defeat the purpose of doing the test. It also helps that we have certified car seat techs who take parents downstairs on d/c and help them install corificeats and put baby in.

mitchsmom · Mar 16, 2011

Hmmm... I think our ped hospitalist is ordering it be done just if

BabyLady, BSN, RN · Mar 16, 2011

So what do you do for those parents who don't use a "bucket" type corificeat for their infant, but instead use a convertible corificeat? Do you require them to lug that whole thing up to your unit (which would mean uninstalling the corificeat, that may have been previously professionally installed)?

We do...absolutely.

..and then we tell them any police station or fire department can recheck it for free because they have car-seat certified employees.

Car seat challenges are not "busy work", they are a necessary part of the discharge process and it disturbs me that it is not considered important We have had several infants that really tank on these tests.

Think about it...baby is placed in a rear facing car seat...you cannot see if it is in trouble...by the time you drive home, it would be too late if something happens.

BabyLady, BSN, RN · Mar 16, 2011

Our unit follows the AAP guidelines without exception. We do car seat trials on all our patients, even the full-term ones. The nurse assigned to the patient is the one who does the trial as part of the baby's stay. We are always in sight of the baby, though, so whether the baby is in a crib or the car seat, it doesn't change anything.
Our bigger challenge is ensuring parents bring in the car seat before the last minute. It's a treat to see parents walk through the doors with a car seat in their hands, they're always grinning because they know they are close to going ____ (shhh, I can't even say the word, I don't want to jinx anything )

We tell parents, "When the nurse tells you your baby is placed in an open crib, you need to bring the car seat in."

We let them know the most of the car seat challenges are completed on night shift and if they get it out of the way, they won't be here all day long on the day of discharge.

hikernurse · Mar 16, 2011

So what do you do for those parents who don't use a "bucket" type corificeat for their infant, but instead use a convertible corificeat? Do you require them to lug that whole thing up to your unit (which would mean uninstalling the corificeat, that may have been previously professionally installed)?

They do have to lug it in, but we do have car seat specialists who are available to place it in their car afterwards. Honestly, in all the time I've worked in the NICU, I've only seen one baby who has used the convertible car seat. I think most parents find them harder to use for newborns than the bucket kind--plus parents find the bucket kind to be cuter:rolleyes:.

We've found that the car seat challenge has identified babies who are unsafe to travel--even those that appear perfectly stable. In that case, we either fix the kid or try a car bed :).