Help! Help! NICU nurses need feedback

Tweety, BSN, RN · Mar 24, 2006

This is the introduction section, hopefully a moderator will move it to the appropriate forum such as the NICU nurses forum and you'll get your answer. I will ask them.

Welcome!

suebird3 · Mar 25, 2006

Welcome to allnurses.com! Post moved; hope this helps!

Suebird

TiffyRN, BSN, PhD · Mar 25, 2006

I'm sure someone would have gotten around to this soon, but I'll go. . .

We had a good discussion about this before that I think you will find helpful:

https://allnurses.com/forums/f33/use-sucrose-nicu-please-respond-131240.html

preemie · Mar 26, 2006

we use sucrose in our unit all the time. We use it for comfort measures and prior to IV attempts. The rep. for sweetease stated it can be given as often as needed and the amt doesn't have to be calculated. We draw it up in a syringe and drip it in their mouth or cheek, then offer the pacifier. You can also dip the pacifier in the solution.

NicuNightRN · Mar 26, 2006

We use it frequently, too, mainly for IV starts and lab draws (as long as they are not NPO). I generally just dip the pacifier into the tub, unless the baby is harder to console, in which case I draw it up in a syringe.

Love_2_Learn · Mar 26, 2006

Hi Everyone,

Does your NICU have an Oral Sucrose Pain Protocol? If so, how is it similar or different from ours?:

Our hospital developed an "Oral Sucrose Pain Protocol" after a few of our well baby nurses were using it to calm fussy babies who were not undegoing painful procedures. Since it's meant for pain relief, babies who are fussy need to be evaluated for the reason, not have some possible problem masked...

Because 24% sucrose solution has a very high osmolarity (700-1000 mOsm/liter) using too much can theoretically cause hyperglycemia, aspiration, and NEC.

We use "Sweet-Ease" from Children's Medical Ventures. We use a fresh cup for each use. It expires rather quickly so we watch the expiration dates; also the sucrose solution can increase up to 40% after 6 months. We give it 2 minutes before a painful procedure. We also use non-nutritive sucking (pacifier) during the procdure since it's been shown to help relieve some pain even without the sucrose. We also try to swaddle, use blanket rolls for containment, have low light and low noise conditions, and gentle handling before the procedure begins.

Uses:

Procedural pain (heel stick labs, venipuncture labs, ABGs, catheter insertion, lumbar puncture, suturing, dressing changes, IM and subcutaneous injections, IV starts.
To help in calming a crying baby who may be experiencing pain and has not responded to regular nursing interventions.
Not to replace narcotics or other pharmacologic measures but can be used in conjunction with them along with nonpharmacological interventions such as pacifier, positioning, swaddling, containment, low light, low noise, gentle handling before procedure, cuddling, etc.

CONTRAINDICATIONS Include:

Preemies less than 32 weeks current adjusted gestational age
Preemies weighing less than 1200 gm
Preemies receiving less than half of their full enteral feeding amount
Any infant with feeding intolerance or abdominal distention
Any infant paralyzed or highly sedated or at risk for aspiration

A MD/NNP order is required to use it in critically ill babies, NPO babies, any baby at risk for NEC. Any physician order trumps the use of the protocol too.

For preemies less than 38 weeks current adjusted gestational age:

We use up to 0.3 ml. This is up to 3 dips of the pacifier into the cup of Sweet-Ease. (Often one dip is enough to soothe them.) If they can't suck on a pacifier we draw up the 0.3 ml in an oral syringe and drip it on the tip of their tongue in 0.1 ml drips.

For Term babies 38 weeks or more current adjusted gestational age:

We use up to 0.7 ml. This is up to 7 dips of the pacifier into the cup of Sweet-Ease. (Often 3 dips is enough to soothe them.) If they can't suck on a pacifier we draw up the 0.7 ml in an oral syringe and drip it on the tip fo their tongue in 0.1 ml drips.

FOR ALL BABIES receiving sucrose:

It can be administered up to 6 times during a 24 hour period.
It is documented on the MAR (time & number of dips/amount in ml and listed as "Oral Sucrose Pain Protocol").
It is documented in our "pain" area of our charting along with the baby's response.

Some of our favorite resources:

Utilizing an Oral Sucrose Solution to Minimize Neonatal Pain, Debbie Gearner Thompson, JSPN Vol. 10, No. 1, January-March, 2005 pp. 3-10.

Totally excellent article!!! Ms. Thompson is NICU Clinical Nurse Specialist at Children's Medical Center Dallas, Dallas, TX. Extensive research was done before they developed a Sucrose Protocol. Her article is about how it was developed, how they implemented it, and how the evaluated it one month and one year after its use began.

(

JSPN

is Journal for Specialists in Pediatric Nursing and is published by Blackwell Publishing Limited.)

Neonatal Medications & Nutrition: A Comprehensive Guide, 3rd Edition, Karin E. Zenk, jack H. Sills, & Robin M. Koeppel, 2003, NICU INK, Santa Rosa, CA, pp.540-543.

"Sweet-Ease" Package Insert, "The Sucrose Solution" Item 99044 Instructions for Use. Children's Medical Ventures.

Neofax 2005, 18th Edition, Thomas E. Young & Barry Mangum, Acorn,

Raleigh, NC, p. 166.

I'd love to hear if any of your NICUs have a Sucrose Protocol. If you do, how is yours similar or different from ours?