flat line eegs...

Gompers, BSN, RN · Sep 22, 2005

That used to happen in our unit, too. We finally addressed it in a staff meeting, basically pointing out that it was very UNsupportive of a co-worker who had plenty to deal with taking care of a very sick baby and mother and his or her OWN emotions.
I strongly suggest that, if you or any of your colleagues are caring for a baby in this situation, bring it up @ a staff meeting, or just take it upon yourself to offer the nurse relief for a short break, to watch the baby during lunch, help getting supplies, or whatever you can do to BE supportive to her. And encourage others to do so as well. And NOT to bring up the ethical issues, criticize decisions, or any of the other similar discussions that just drain emotional energy from the nurse. Offer help and support to mom as well.
It really makes a HUGE difference in dealing w/a tough situation.
Just my

I spent many mornings in my manager's office talking about this situation. All that came of it was that a series of ethics meetings took place on the unit so that the staff could express their opinions, and so the ethics committee could explain that they were involved with the case and supported the family. I didn't attend these meetings, as I felt my presence might prevent other nurses from really expressing themselves. I don't remember feeling any more unit support afterwards. The whole situation just sucked. We haven't had such an extreme case since, but I KNOW that if it happens again, I will make it a point to make sure the nurses who care for that baby feel supported. It's not our choice to keep a baby alive, and just because we might be close to the family, it doesn't mean we have the power to persuade them to change their minds! Instead of stating the obvious - it's a futile case and we're doing more harm than good - why not just be there for the nurse when she needs a friend. It's exhausting caring for infants in these situations, and even something as simple as a hug can really help.

fergus51 · Sep 22, 2005

I primaried a baby that everyone thought would die (including me) but the parents insisted on treatment. Fortunately the baby did extrememly well and went home, but I had a lot of those moments with my coworkers ("How can the parents torture their baby like this?"). It did upset me. At the same time, I know I've said those types of things when I was frustrated and sad too so I had to be forgiving of it. I never went to the manager because that never accomplishes anything in my experience. I would just be blunt with the nurse giving me attitude at the time. Something along the lines of "I can't convince the parents to withdraw and as long as the baby is alive I would appreciate your support because it's hard for me too. Comments like the ones you're making hurt my feelings. The parents know what the outcome will likely be". I really don't think anyone means to be unsupportive of you. I think they just lose sight that of your pain when they feel their own sometimes.

Bailarina · Sep 22, 2005

I think all parents believe in miracles and are praying for one. I believe that it is their child so it is ultimately their decision and I support their decision however hard that may be.

sparkyRN · Sep 22, 2005

Think about the parents. They can't see the proven stats or high morbitity and mortality. They just see their precious baby. I have been trying to have a baby for a long time now (too long), and I can see myself finally having a baby, and having it end up in NICU. I would want to spend every minute with my baby-I would want to be a mother for as long as I could. I would want my baby on this planet for as long as possible.

Yes, you would to a point.

The overpowering urge to be a mother to your child can not be stopped just because clinically the baby may only be alive because of an ETT and vent. But as the days go on and no improvement is seen, loving parents realize they have to accept what is inevitable. The greatest love of all is denying one's own needs to meet the need of one's child. A woman may need to be a mother, but overriding that will be her need to protect that baby from pain. Sometimes the only way is to let go.

nurseiam · Sep 26, 2005

We have had similar cases in our unit. It is very hard!

A few years ago we had a birth trama, the initial EEG was flat. They gave the parents sveral days before talking to them. By the end of the week she was off the vent. She went home brestfeeding by day 10. I always remember that family and pray that that will happen , but it usually deosn't.

Gompers, BSN, RN · Sep 26, 2005

We have had similar cases in our unit. It is very hard!
A few years ago we had a birth trama, the initial EEG was flat. They gave the parents sveral days before talking to them. By the end of the week she was off the vent. She went home brestfeeding by day 10. I always remember that family and pray that that will happen , but it usually deosn't.

But how is she now?

I see stuff like that happen in our unit, either bad asphyxia babies or preemies with grade IV bleeds - and they're doing great when they go home. Then my coworkers remind me, "It's easy being a baby" and that once it comes time to do more than suck, swallow, and breathe, things might not look so normal.

sanctuary, BSN, MSN, RN · Jan 8, 2006

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Hello, rainbows4me,
Yes, most definitely litigation issues. I know, it is one ..... if not THE most frustrating and heart breaking scenerios. But, when a healthcare provider starts to practice euthansia, well...........

Greetings. Is taking a body off of artificial support euthanesia? Seems like the trouble began when we failed to answer the question "Just because we can do it, does it mean we have to?" Perhaps refusing to begin would be the kindest measure.

Gompers, BSN, RN · Jan 8, 2006

Greetings. Is taking a body off of artificial support euthanesia? Seems like the trouble began when we failed to answer the question "Just because we can do it, does it mean we have to?" Perhaps refusing to begin would be the kindest measure.

You don't have that option, with babies. If a baby is over 400 grams and 23 weeks gestation, we are supposed to intubate and try to keep them alive. Same with an asphyxia baby - you don't go into a delivery room and just say, Nope, we're not trying. This is someone's baby, and we really don't know how they're going to do until later. So yeah, we try to get them back - and if after 15 minutes of CPR the newborn is still down, then it's over. But it's very hard, in NICU, because this IS someone's precious baby, and by hospital guidelines, we DO have to try. It gets very sticky later on, if the baby really is bad, and it's nice to say that maybe we shouldn't have started. But we don't have that option at the beginning, so it's a moot point.

It's not euthanasia to remove life support.

http://www.google.com/search?hl=en&lr=lang_en&c2coff=1&oi=defmore&defl=en&q=define:Euthanasia

Removing life support is truly just doing that - removing the support that a person needs to live. Euthanasia is actually GIVING something to KILL somebody painlessly, and usually instantly. But taking someone off the vent who is very sick, adult or child, is not actually killing them. It's proving that they are so sick that they cannot survive without machinery. It's called letting them go.

prmenrs, RN · Jan 8, 2006

It's called letting them go.

And sometimes it's just as hard for us as the parents. Most times NICU is the toughest, most awesome job there is; sometimes it just breaks your heart.

I am so very grateful that, on rare occassions, I have been allowed to take a baby to a private spot and hold it till it leaves us.

cathys01 · Jan 8, 2006

Mine is a fairly small level II/level III unit. We get about 500 babies a year total.

I've only seen one case in the last year that we removed from life support...it was a mermaid baby with no kidneys and the doctors told the 15 year old mom that there was no hope, she agreed to remove the baby from LS.

One other case of a baby with a flatline eeg, no response to anything, constant seizures. Docs talked to parents but parents refused to remove, had baby transferred to another hospital for evaluation...where life support was removed and the baby was allowed to die.

Keysnurse2008 · Jan 8, 2006

e
Hello, rainbows4me,
Yes, most definitely litigation issues. I know, it is one ..... if not THE most frustrating and heart breaking scenerios. But, when a healthcare provider starts to practice euthansia, well...........

But...this child meets brain death criteria.I am not a NICU nurse...but rather NEURO ICU. When there is an anoxic brain injury that is so profound that you have no alpha/deltas etc etc or any activity seen on a EEG...blown pupils etc etc...accompainied with MRI's to back up herniation dx.Will the insurance compainies pay...for this parents inability to grasp the finality of the situation...and if so...for how long? In the NICU....in situations like this.....do you bring in your ethics represenative alot...to assist your physicians and nurses when dealing with these heartbreaking mom and dads who just cant let go?Thanks for the insight...as I said Neuro-adult I know......but kids....is a lil different I am sure .So I would appreciate your insight on how you handle these situations also...thanks!!!

Undecided7 · Jan 9, 2006

I know in Nevada at least, if someone is tested (like with an EEG) and there is no brain activity and brain death is confirmed, they cannot be kept on life support unless it's an organ donation case (which usually applies more with older kids and adults). It's against the law to cause death, but who's playing God here?? Keeping a dead person hooked up to machines that keep the body going is not only stupid- it's illegal. :nono:

If the parents can't accept it and want to take the dead baby home and pretend it's alive- well that probably breaks some health codes too, but I know the baby would be discharged from the hospital. We try our best, but once the person (adult or baby) is dead- it's dead. And they sure don't continue to be treated.