I am wondering how ya'll deal with a kid on NCPAP. I am a GN an just started working in NICU a couple of weeks ago.
Are all kids on NCPAP so crabby? The little one I had yesterday was just miserable. I was trying my hardest to get him comfortable, keep his nose for breaking down anymore, and keep his pressures up. He wouldn't tolerate any other position than prone which just kept squishing his nose on the mask.
He was a 31 weeker who HATED to be touched. It just seemed like a struggle all day long to keep him comfortable and properly maintained.
Heather 333, looking back, how do you feel about being a new grad RN in the NICU. I just graduated an am about to embark on the same journey and am getting a little anxious. If anyone has any advice for a new RN in the NICU, it would be greaty appreiciated.
I feel very comfortable as a new grad in the NICU. I have a wonderful preceptor and very supportive staff. Also, out neonatologist is a great teacher and enjoys new grad.
Now that I have been in NICU, I can't imagine doing anything else.
I despise CPAP, but at least they aren't on the vent! We nest and swaddle, give a pacifier with glucose on it. We don't sedate our kids on CPAP, we will beg to change to a high flow cannula and then PD/C them to keep them open! We have gone as high as 2 1/2 L! Also...we sink an og to keep their tummy from getting full of air. If they are feeding we close it for about an hour and then vent it. Also, put some duodurm on their septum and upper lip...it helps keep the prongs in place and helps cut down rubbing :)
We don't give Tylenol to kids less than 2 months because of liver immmaturity. Also no sedatives unless intubated. We use Lidocaine gel lightly in their nares - I notice no ne else suggested this - is there a reason we shouldn't be using it that I don't know about???
A few people mentioned placing the baby prone, but our NICU no longer accepts that in our policy, due to babies getting necrotic nasal septums. When the baby is prone they are morelikely to have the CPAP nasal prongs press their nasal septum and cause pressure which increases the chances of necrosis of the nasal septum. We have a policy to now only let the babies lie supine and the respiratory therapists must check the nasal septum every two hours. I definitely recommend swaddling the baby tight and using a pacifier.
We also switch back and forth b/t prongs and the nose cover thing... cant think of what it is calld.
Also, I thought that pignoses were a result of the prongs being placed wrong. We really dont have too much of a problem with breakdown. I really think it has a lot to do with the fact that we dont use the prongs all of the time. The kids really seem to like the cover better.
NICUNURSE
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Heather 333, looking back, how do you feel about being a new grad RN in the NICU. I just graduated an am about to embark on the same journey and am getting a little anxious. If anyone has any advice for a new RN in the NICU, it would be greaty appreiciated.