So I have this baby right now with prenatally dx'ed dilated cardiomyopathy, at our hosp for transplant eval. She's really little, only 2kg, so I have a feeling her chances of getting a heart are slim. She's really quite stable, but intubated with a UAC. I'd really like for mom to get to hold her at some point, but our unit doesn't usually allow holding with any intubation, and almost never with a UAC. Not that it's forbidden, exactly, but it's just Not Done. I'm very seriously considering asking mom if she wants to hold tonight. I weighed the baby last night as a sort of trial run for myself to see if I could safely get her on and off the bed, and it went fine.
My question is this: do any of you lovely folks who routinely allow holding with intubations and UACs have any tips for me? Other than, you know, "Make sure the UAC is well secured"? That's sort of a given, yeah?
Specializes in MedSurg-1yr, MotherBaby-6yrs NICU 4/07.
We usually have at least another nurse besides ourself, and an RT there for the transition to and from the incubator. While Mom is holding, we are there to monitor baby for tolerance of being out, and have an RT and a nurse on a short leash in case we need them back in a hurry. Just plan your move well, and have lots of spare hands around.
Most of our kiddos with UAC's are too sick to be held. We don't leave the lines in more than 5-7 days unless the kid is very sick/unstable. If the baby is dying or super critical with a poor prognosis, we will take the baby out, but no kangaroo positioning. They are on a pillow and mom can put her hands under baby and we will help her to lift baby up for a kiss.
I asked some other nurses in our unit about this and I was told that we don't let them hold a baby with a UAC for fear of not being able to see the site and if something went wrong, they could do some serious bleeding before we could do anything. I think that may be a little overly cautious. Someone pointed out that they're sutured in and with adequate care and help in moving I would think it would be safe.
However, they all said that if the kid was not doing well and it didn't look like a good prognosis, they'd do it to give mom a chance to hold the baby. It sounds like this baby might not make it much longer? You said you had doubts about a new heart. I think that if it were me and my baby might not survive, I'd want to hold him and take extra precautions with the lines and tubes.
Just to note- our umbilical lines are not sutured in. They are most places, but we only do it if there's excessive bleeding after placement.
The mom ended up not coming in that night, so it was a moot point, and the baby has since been extubated. She's going to hang out on CPAP for a while and get bigger, since there's no way she'd get a heart at her size. She's doing inexplicably well. If we can get her off milrinone and onto digoxin for function, we might send her to a long-term facility for a while, since at that point all she'd be doing is eating.
I've done kangaroo care with babes under a kilo. Lines and tubes shouldn't be the issue so much as if the baby tolerate the move. I wouldn't move a kid on vasopressors if I could avoid it. Moving a baby with lines and tubes just takes some planning and preparation, and plenty of hands. Measures need to be taken to not stress the babe out - quiet, low lights, etc. Think of the service you are doing to that baby and parent and how they will benefit!! I've seen critical babies have their best shift after a couple of hours on mom or dad's chest. Take advantage of the honeymoon period if you can. It may be the only chance parents get to hold their child alive.
Here's a link that talks about how to kangaroo care a critical babe:
nursecave
50 Posts
We usually have at least another nurse besides ourself, and an RT there for the transition to and from the incubator. While Mom is holding, we are there to monitor baby for tolerance of being out, and have an RT and a nurse on a short leash in case we need them back in a hurry. Just plan your move well, and have lots of spare hands around.