daily weights in your unit?

Pediatric Critical Care Columnist · Aug 1, 2012

We only do daily weights on our chronically-critical infants to ensure they're getting enough calories for growth. We might have one or two at a time on the unit. Our I&O are as accurate as we can make them so they're a good guideline for what the kid is doing. When we do weigh our babies we usually use the crib scale but for some of them we use the baby scale - whatever is documented on the Kardex. RT helps with tube securement to avoid unplanned extubation and when using the baby scale, having more than two hands is always a good thing. Somebody's got to hold up all the lines and cables! I like to put a layer of receiving blankets on the scale before it's turned on so the tray is padded and the baby is distressed as little as possible. (I do the same thing with dry diapers... the scale does the math for me.) It shouldn't matter what's on the bed when the bed scale is zeroed, because the patient is lifted clear and the scale zeroed with whatever is on it. It starts at zero no matter what. Having said all that, I don't think daily weights are reasonable, necessary or safe. Why don't you ask your policy-makers for EBP for daily weights and see what they come up with?

umcRN, BSN, RN · Aug 1, 2012

We do daily weights on everyone unless they're on ECMO or immediately post op. For our infants (many in our cardiac ICU) it helps with ensuring they're getting enough calories for growth (though I think daily is a little much, in the nicu we would weigh 3 times a week). It's kind of silly too because for infants the docs won't change the med calc weight until it's almost a kilo difference, and the change is usually made because the nutritionist wants to pack more formula/calories into them. Yes it also shows how much fluid theyre packing on but we do strict, hourly I&O and if they've got enough fluid on to make a significant weight difference you can usually see it on them

We do have bed scales in all our beds except our cribs but we do not put intubated patients in cribs (and if they crash and need intubating while in a crib we switch them to a warmer/bed as soon as possible)

If, for whatever reason, the bedside RN does not think a weight is in the patients best interest, no one is going to argue about it

Double-Helix, BSN, RN · Aug 1, 2012

We rarely do daily weights in our PICU. Typically, our cardiac patients are on daily weights, but that's about it. We do once weekly weights on all our other patients. While most of our beds have scales, our cribs do not, and a kilo difference makes much less difference on a teenager than an infant. We very rarely weight our intubated, sedated patients unless there is a really clear benefit. If we did weigh them, we would probably use a neuromuscular blockade (for the infants/young children) to reduce the risk of unplanned extubation. We also do very strict I&O, so that's our primary method of assessing fluid balance and weight gain.

meanmaryjean, DNP, RN · Aug 1, 2012

We weigh weekly except in very rare (FTT) instances. Sunday - day shift. Another good reason not to work days! :)

picurn10 · Aug 2, 2012

Very interesting to have the other perspectives, thanks!

Janfrn, just to be clear, I do understand how zero'ing works Our problem is that often the nurse zero'ing the empty bed forgets to list what it was zero'd with, so then as the days pass and more and more stuff winds up on the bed, there is no way to know how to clear the bed to get an accurate wt. Was there one pad or two? a flat sheet and a blanket, or just a sheet? and so on... Then you have to get the pt onto the sling scale just because no one bothered to write down how the bed was zero'd, we don't have a policy in place that says always zero with xyx, or something like that.

I just feel like its an out of date policy that causes major upset and headache to the families/pts/nursing for no reason. You all have confirmed my "hunch", now I just need to hunt down some research on the subject if there is any.

Pediatric Critical Care Columnist · Aug 3, 2012

I think you were missing my point. It doesn't matter what was on the bed when it was zeroed. You could have a truck on there and when the bed is told to zero, it goes to zero. Take the truck off and then you'd have -5000 pounds. What would matter is what is on the patient. Dry diaper? Wet diaper? Dressings? What's hanging off the patient that might be touching the bed? A full JP drainage bulb or bile bag? 5 stopcocks on the CVL where there was only 1 before? That kind of thing will make your weights fluctuate but not having an extra soaker pad on the bed at the time it's zeroed.

Double-Helix, BSN, RN · Aug 3, 2012

I think you were missing my point. It doesn't matter what was on the bed when it was zeroed. You could have a truck on there and when the bed is told to zero, it goes to zero. Take the truck off and then you'd have -5000 pounds. What would matter is what is on the patient. Dry diaper? Wet diaper? Dressings? What's hanging off the patient that might be touching the bed? A full JP drainage bulb or bile bag? 5 stopcocks on the CVL where there was only 1 before? That kind of thing will make your weights fluctuate but not having an extra soaker pad on the bed at the time it's zeroed.

I think what picurn10 is saying is that they do not re-zero the beds before obtaining a new weight. They zero the bed initially, but then use that same setting each day so that they don't have to lift the patient and re-zero the bed. So if on admission the bed is zeroed with just a sheet, then the next day the bed is not zeroed, but has three extra blankets, the weight could be off.

picurn10 · Aug 3, 2012

lol, I do understand the concept of zero'ing a bed Ashley is gettting what I'm saying. So, day 1 the pt bed is zero'd w/ a sheet and one pillow. No one writes down what was on the bed. Day three I come in to weigh the pt and now there are 15 pillows on the bed, five blankets and two sheets. Because I don't know what was on the bed day one when it was zero'd, the only way to get an accurate weight is to get out the sling scale (usually at 2am) and get the intubated/lined out pt up off the bed so I can rezero it. Ideally, if the bed was zero'd day one, I shouldn't have to rezero it, just push the weigh buttons on the bed. In the short term the solution is for people to keep better records of how the bed was zero'd, but ultimately it comes down to how much risk/pain/stress we put the pt through to have that daily weight.

Pediatric Critical Care Columnist · Aug 3, 2012

Ah. I see what you're talking about now. We don't follow that practice at all so I was confused. You're totally right, the person doing the initial weight has to take responsibility for ensuring that list is made and then every night the inventory can be checked. When we weigh our kids we always start from scratch. Sorry for being a snot.

picurn10 · Aug 3, 2012

lol, I didn't pick up on the "snot" vibe, but apology accepted :)

SprightlySparrow, BSN, RN · Aug 6, 2012

I may be totally missing something here, but can y'all not just lift the patient, zero the bed w/everything on it, then weigh the patient after he/she has been placed back in the bed?

Our Panda beds as well as some of our cribs have built in scales, and we always use this method (lift child, zero bed, weigh child...). I will say we also have a standing scale and a regular baby scale we utilize at times, too. We weigh every patient weekly (as long as they as stable) and our chronic feeder/growers get weighed daily or at least 2x/week. Our stepdown unit does daily weights every night around 8pm as a standard.

Of course the weights we obtain will be less accurate with all the "gear" our patients have in the ICU (leads, chest tubes, ET tubes, manifolds, etc etc), but we do the best we can. Sometimes we need a third person to help out. Our physicians/NPs more or less understand the difficulty, however, and I feel they view the weights from a nutrition perspective as opposed to a fluid balance one. We use very strict electronic charting for that.