Help! Help! NICU nurses need feedback

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!

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

Suebird

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

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.

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.

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:

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

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.

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?