Does your Nicu allow holding with UAC

[shadow2k6]

Hello all there, this is my first time posting so if i mess up I am sorry. I work at a rather large level 3 NICU and are always trying to keep up to date on a lot of things, but we are having discussion regarding parents holding/or kangaroo care with an infant who has a UAC or radial art line. We sometimes keep those lines in for weeks if we cannot get any other access. Some quote it as policy, but I think it is safe under supervision. When you tell a mother she cannot hold her otherwise stable infant due to the fact her infant has a arterial line, it does not promote bonding. Just wanted to know if any of your NICU's have similar policies.

Thanks all

[BittyBabyGrower, MSN, RN]

Radial art lines...as long as the baby is stable and has stable BP's yes and not on vasopressors...yes.

Umbilical lines...no, unless the baby is dying. I know that sounds awful, but we had two instances where the lines were dislodged.

[dawngloves, BSN, RN]

If a baby has a UA or PIA on our unit, it's not really stable. I know some nurses have let a mom hold with lines in place,but I won't do it.

[LilPeanut, MSN, RN, NP]

radial art lines yes, UACs no.

[Jolie, BSN]

I worked in one unit that allowed any baby who could tolerate it to be held. I never saw a line or ETT tube be pulled out because of it, but saw plenty pulled out due to restless babies with inadequate pain management or sedation!

I worked in another unit where it was strictly prohibited for any baby with a line or ETT to be held. It was terribly sad because some parents waited months to hold their infants, and some babies died without ever being held by their parents. I truly think it was more of an issue of closed-mindedness on the part of the nursing staff than any real safety hazard.

It needs to be decided on an individual basis, not a strict unit policy. In some cases it can be safely done, in others not.

[Ms. RN'02]

When I was a NICU nurse I never let a parent hold with a UAC in place. Instead I would let them do other things that got them involved in the care of their baby. This was a very common practice for most nurses on the unit.

[ncbeachgrl]

At my last hospital, we would let parents hold with an ETT in place, but not with umbilical lines. At my current hospital, I see nurses letting parents hold with umbilical lines but not if they're intubated or even on CPAP. It cracks me up! We keep lines in way too long here, so I don't mind letting parents hold with them. I think it's a nursing preference, how stable the infant is, and knowing that the nurse is ultimately responsible should something happen. I will say that my current hospital does a much better job securing lines so that may be the difference between here and my last job.

[fergus51]

I assess the situation and act accordingly. We don't have policy forbidding it, so if I feel a parent can be trusted to hold with lines and the baby is stable enough I'll let them. I've never had a line pulled out in this way. I've worked in some hospitals that keep lines in for a long time just for bloodwork (not because the baby is unstable). I can't imagine not letting parents hold their baby for weeks in that case.

[lovemyjob]

I think it def depends on the situation. We willl let parents hold as long as they are stable or if they are in the process of dying. We let them hold babies even intubated (except for HFOV..which usually implies instability.) I dont have a problem with art lines, as long as the parents are made to understand that if this line comes out, the baby may be too far gone before we even realize it. When the parents understand how dangerous the lines are, they are pretty cautious. I tell them to ask me before they switch who holds. I also wrap the lines up in the blanket so the stopcock is wrapped up as well as most of thel line. I think as long as the parents are closely supervised and well informed on careful handling, there should be no reason to prolong a parent bonding with their baby

[Sweeper933]

On our unit, parents are not allowed to hold as long as their baby has a UAC/UVC in. We let them know the importance/fragility of these lines, and for the most part, they understand. As far as venting/holding - we're all for it. As long as the baby is having a good day - gaining weight, warm, not desating too much... Parents are usually pretty understanding about not being able to hold/kangaroo if their baby is having a bad day. Once and a while, we do have a kid extubate while being held, but it's usually a kid who extubates every other day anyway... We use lots of clear tape to firmly tape all of the tubing to the recliners

[shadow2k6]

Thank you all for your time in responding to my question. I have a better understanding and will approach the situations appropriately. I have to say this message board has been very helpful in helping me keep a open mind in caring for our littlest patients.

[NiteRocker]

No to belly lines, unless there is a doc's order. Parents seem to understand for the most part.

It's just to easy to displace lines...feeding, ETT, UA/UV's. So, anytime a parent desires to hold we go through the whole senario. Mostly, holding of infant in this category is done on day shift. Docs are readily available if an issue arrises. Parents learn the rules and we go from there.