Gastroschisis Post Op

Jory, MSN, APRN, CNM · Apr 30, 2013

We use a fentanyl drip for 48 hours and then change to Q 4 morphine for 48 more, then it's changed to Q6 for 24 and then PRN.

It's important that the baby get assigned to nurses that don't have hang ups about pain medications. I have seen babies get left in HORRIBLE obvious pain because some idiot thought that it was appropriate to stop pain meds after 24 hours.

NicuGal, MSN, RN · Apr 30, 2013

We start them on a gtt, our surgeons like to keep them out for 5 days postoperative and then we start to wean the drip until we can turn it off, usually over a week. It is a 10% wean per day as tolerated. We usually treat them as a withdrawal as we keep them pretty snowed until they get closed up.

prmenrs, RN · Apr 30, 2013

"...It's important that the baby get assigned to nurses that don't have hang ups about pain medications. I have seen babies get left in HORRIBLE obvious pain because some idiot thought that it was appropriate to stop pain meds after 24 hours."

This is soooo true. I can't tell you what fun it is to get report from someone who didn't medicate the baby the whole shift cuz "they didn't need it". What??? Do they think the kid will put their call light on and REQUEST pain med? :mad:

I'm going to spend the whole shift trying to get pain back under control. Gut babies are miserable customers!!! If your unit has volunteer 'cuddlers', grab one the minute they come in! Hard on the parents, too, who keep asking what they did to cause this.

These are the most challenging patients, imo. If you get a routine that works,stick w/it. Good luck!

Jory, MSN, APRN, CNM · May 1, 2013

"...It's important that the baby get assigned to nurses that don't have hang ups about pain medications. I have seen babies get left in HORRIBLE obvious pain because some idiot thought that it was appropriate to stop pain meds after 24 hours."
This is soooo true. I can't tell you what fun it is to get report from someone who didn't medicate the baby the whole shift cuz "they didn't need it". What??? Do they think the kid will put their call light on and REQUEST pain med?
I'm going to spend the whole shift trying to get pain back under control. Gut babies are miserable customers!!! If your unit has volunteer 'cuddlers', grab one the minute they come in! Hard on the parents, too, who keep asking what they did to cause this.
These are the most challenging patients, imo. If you get a routine that works,stick w/it. Good luck!

Sister....Amen to that!!!!!!!!!

prmenrs, RN · May 1, 2013

ps--Use abstinence scoring on these babies. Gives you a "number" to tell the docs. If they have a pain service, (usually anesthesia) engage their services.

Bortaz, MSN, RN · May 3, 2013

This is soooo true. I can't tell you what fun it is to get report from someone who didn't medicate the baby the whole shift cuz "they didn't need it". What??? Do they think the kid will put their call light on and REQUEST pain med?
I'm going to spend the whole shift trying to get pain back under control.

This is absolutely my biggest pet peeve in the NICU. DRIVES ME CRAZY. It's like the RNs don't have any concept of pain or pain management. Same with the nurses and docs that won't medicate the wildly thrashing, soon-to-extubate-themselves kids on HFJV or HFOV.

NicuGal, MSN, RN · May 3, 2013

We have one dinosaur attending that doesn't like to give "too much Meds" because he doesn't want them to third space. Really? That isn't what causes that! Ugh!

prmenrs, RN · May 3, 2013

Gut surgery, esp gastro and oomphalocele, kids are going to third space whether they get pain meds or not! That's what happens when the sturgeon plays around in there. @NicuGal, that would just frost my cookies. I'd have to hurt him.

OK, I think I'm ok, now. Sorry.

prmenrs, RN · May 3, 2013

We had an anesthesia doc who had done a NICU fellowship--he was worth his weight in gold! Sometimes he would put an epidural in them--that really helped.

NicuGal, MSN, RN · May 3, 2013

Believe me, several of us went round and round...still do! I don't get why they hate Meds and sedation.

We had one like that too! He never intubated or old chronic kids for hernias, he would put an epidural in! We were so sad he retired! He was, and still would be, one I really trusted with our kids!

NeuroRN123 · May 7, 2013

Thank you all for your response. I find it so frustrating when you are fighting with the surgeon or neo to give them something...when you know the baby is in pain.