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Dr. Brown Nipples....

Posted

Specializes in NICU, PICU.

...are the worst.

Are other units jumping on the Dr. Brown nipple train? My unit is no longer stocking disposable nipples, so everybody gets a Dr. Brown.

We've had some issues with them not being cleaned sufficiently, which is super gross. Our coordinator recently sent out an email saying that 'milk scum' had been found in the crevices of several bottles that had just been 'sterilized' in the microwave sterilizer bags. It kind of makes sense, though: if you've got three feeder-growers who PO q 3, and you take five minutes to adequately wash the bottle after each feed, that's exactly 60 mins spent washing bottles per shift--ain't nobody got time for that!! :bored: I'm not all that surprised that nurses are cutting corners, even though that's a huge, nasty infection risk. I've also had some nipples that were not rinsed sufficiently, and so the baby would make a grossed-out, scrunched-up face and reject the bottle (I would too, if it tasted like soap). Surely, that kind of negative stimulus must not be helpful when it comes to the development of oral aversion.

To be fair, I went to a neonatal feeding conference where the speaker presented research which found that Dr. Brown nipples are actually the best for the babies. Apparently most nipples are pre-made, and the appropriate sized hole is stamped in the middle depending on flow rate; the holes can close up over time, which means that an old standard-flow may actually be slower than a brand new slow-flow. Meanwhile, the Dr. Brown nipples are apparently built around the hole, so it never changes size and the flow is more consistent.

I get that some kids seriously do need a Dr. Brown nipple since the disposables aren't working out for them. However, my current hospital is doing it specifically as a cost-saving measure (since one Dr. Brown bottle costs about $5 and can be reused, whereas the disposables are apparently around $1 each).

If every kid gets a Dr. Brown, it would be nice for units to hire someone who is solely responsible for washing the d***ed nipples, since it seems unrealistic to squeeze an extra hour of work to an already busy 12 hour shift.

Rant over, carry on.

Edited by adventure_rn

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

OK- I'm gonna be completely transparent here and admit that even though I know what those awful contraptions are- I took the title of this thread in a completely different meaning. :) Not proud of that...

adventure_rn, BSN

Specializes in NICU, PICU.

OK- I'm gonna be completely transparent here and admit that even though I know what those awful contraptions are- I took the title of this thread in a completely different meaning. :) Not proud of that...

Hahaha, oh dear, just realized that the word nipple, while commonplace in the NICU, probably isn't the best word to be throwing around willy nilly in a public forum. NICU nurses spend a shocking amount of time talking about non-human plastic nipples. Maybe Dr. Brown bottles would be a better phrasing. :sarcastic:

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KRVRN, BSN, RN

Specializes in NICU.

Is this a full Dr. Brown bottle with a straw down the middle all the parts or just a nipple and ring like the disposable ones? Dr. Brown bottles have about 5 pieces to each bottle and if you're having to wash all the pieces it's a matter of time before SOME part doesn't get fully washed.

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

Hahaha, oh dear, just realized that the word nipple, while commonplace in the NICU, probably isn't the best word to be throwing around willy nilly in a public forum. NICU nurses spend a shocking amount of time talking about non-human plastic nipples. Maybe Dr. Brown bottles would be a better phrasing. :sarcastic:

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This too...

adventure_rn, BSN

Specializes in NICU, PICU.

Is this a full Dr. Brown bottle with a straw down the middle all the parts or just a nipple and ring like the disposable ones? Dr. Brown bottles have about 5 pieces to each bottle and if you're having to wash all the pieces it's a matter of time before SOME part doesn't get fully washed.

Oh, all the pieces, all the time. Plus, if you're juggling five pieces while trying to sufficiently wash and rinse them all, it's only a matter of time before a piece falls on the ground (*gag*).

OMG. This issue is my worst nightmare (OK, being a little over-dramatic there, lol). I hate having to clean all those little pieces and the nooks and crannies all the time. Luckily, in my unit we still primarily use disposable bottle/nipple systems, but have the parents bring in a home bottle system when baby gets closer to discharge. Our unit is so pro-Dr Brown's that they got the hospital to stock them in the gift shop, so it would not surprise me at all if we make the transition to all Dr Brown's all the time. :cry:

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

We throw ours in a bin at the baby's bedside in hot soapy water to soak and then washing out when we can. They get out in the microwave once a day. They are a pain! We only use them if parents bring them in.

We still use disposable nipples and bottoms and only use Dr Brown bottles in special situations but they are really expensive is it really a cost savings in the long run?

adventure_rn, BSN

Specializes in NICU, PICU.

We still use disposable nipples and bottoms and only use Dr Brown bottles in special situations but they are really expensive is it really a cost savings in the long run?

That was my thought exactly, but apparently they actually pay for themselves in a few days (especially if you have chronic kids who are going to use disposables 6-8 times a day every day for months). According to our 'higher ups' the disposables cost about 1/5 of the Dr. Brown, so after 5 feeds you break even.

My bigger cost concern is that we have lower-SES parents who get upset because they can't afford to continue to use Dr. Browns when they go home. They're worried about inconsistency if they have to switch to a cheaper nipple. Consequently, there are then diversion issues with parents taking extra Dr. Browns and cleaning supplies so they don't have to pay for them when they go home (which, again, defeats the Dr. Brown cost-savings concept).

needlesmcgeeRN, ASN, RN

Specializes in Care Coordination, Care Management. Has 3 years experience.

What about central processing or whatever the department is called at your facility? I mean, I am sure they would not be appreciative of more work on their department, but...they're already the department responsible for sterilization, etc. They are (SHOULD BE) trained in proper sterilization techniques.

Baby Wrangler

Specializes in NICU.

Can't management shell out to get a dishwasher just for pumping equipment and bottles? We just got one last year for the moms to wash their pumping equipment and baby bottles. You can disassemble the Dr. Brown's and stick the little pieces in a mesh bag that you can put in the dishwasher. Like someone said, ain't nobody got time to be washing bottles if you have three bottlers, plus dumping all the dirty water into the sinks lead to Serratia in the pipes. Plus this way, the moms can wash the bottles themselves.

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

Most units wouldn't have the room or hookup for a dishwasher, and I wouldn't trust central supply to not lose or ruin them. You should be sterilizing them in the bag they come with once every 24 hours.

I hate Dr. Browns and I think the whole silly contraption doesn't do a damn thing to limit air swallowing. We have brushes to clean parts and we have bags so that we sterilize them each night. I had no idea they had one use ones that don't include that idiot contraption in the middle.

preemiepoweredRN

Specializes in NICU.

I totally agree! Its almost like the hospitals are getting them for free or something.. It seems like I blinked and suddenly every baby has a Dr. Brown bottle. There are definitely benefits to bottle system, but infection risks definitely cannot be ignored.

In the two different hospital NICUs I have had experience with, neither used DB unless kiddo had been assessed by either OT or Speech Therapy and it was determined a necessity. In both places, the parent/s were responsible for taking apart and washing each piece of the contraption. We provided dish soap/washing bin. But we the staff were not allowed to wash the contraptions since it was a "liability issue" if they were not cleaned properly.