How often do you "care" for your nicu babies?

[1/4lberrnc]

I have recently started a new job, after the hospital I was happily working at closed our OB/NICU department to make more telemetry beds. At the NICU that I am leaving we did every 4 hour care (ie VS, full assessment and feeding etc...) and our care times were staggered (9-1-5/ 8-12-4/ 10-2-6). At my new hospital it is every 3 hours but staggered also. The hospital that I trained at before going to the hospital that is now closing did every 3 hour care but at set times for every baby (3-6-9-12). How does your NICU "care" for their babies? I would like to know the pros/cons too. Thanks you in advance for your input.

[Humbled_Nurse]

Well it depends on the baby. If the baby eats every three hours then it is hands on care every three hours. If the baby is NPO then it usually hands on care every four hours. It is especially important if it is a new micro- preemie to have limited "touch time".

[cshell1964]

We used to do everybody every 4 hours at 10-2-6. That was a looong time ago. Now mos kids that eat are either every 3 hrs or on cue-based feedings where they eat every 2 1/2 - 5 hrs when they wake up and act hungry. Schedules vary now too. It just starts whenever the first feeding was. NPO babies are done every 4 hrs, usually 8-12-4, but we can change the times to make it more convenient.

[BittyBabyGrower, MSN, RN]

Depends on the kid. For feeders, if they are ng feeding, we bug them only every other feed, unless they have had gut problems and need a belly check every feed. For the every other ngers we only bug them when they PO feed. They do much better with the uninterrupted sleep. Q2's and NPOS...usually every 4, the feeder ones, we do check girths every 2-4, depends on the kid. The NPO's we tend to leave them alone, esp if they are screamers! We will go every 6 with them.

Our sicker kids, we will let go every 6-8 hours, even up to 12 if they don't require frequent suctioning. Most of the smaller kids with RDS don't have much down the tube, so we will leave them alone in their nests. Our motto is "Let a sleeping baby lie" :)

We have 2 q3h feeder schedules so that if you have 4 kids and they all eat, then at least you only have 2 due at a time.

[dawngloves, BSN, RN]

Full assesment? Every 6 hours.But if they're stable PO feeders we'll do a diaper change and feed q3.Unstable we'll let them be for q6, unless we are in there for another reason (retaping ett, xray, ect.) we can do a quick assesment and diaper change. We cluster care in order to let them be as long as possible.

Feeder/growers on q4 feeds we do a qshift assesment.

[lovemyjob]

q 12 temp and BP and q 4 monitor VS (8-12-4.) diaper changes depending on the kid. We dont really have set diaper change quidelines, it is up to the nurses judgement to determine what that particular kid needs. We also agree with the "let a sleeping baby lie" (especially those cranky gastros!!)

[SteveNNP, MSN, NP]

Micros- full assessment q6 with diaper change and reposition "hands off otherwise" q2h monitor VS

NPO/PO/OG non vented, non UA/UVC, Art line kids- Feeds/VS/diaper/Tube&Belly check q3 unless ordered ad lib or q4, assessment q12 (q6 if acting funny)

These are obviously flexible according to the babys needs......

[1/4lberrnc]

Thanks for all the responses. I love the information I am getting. I am very new to this site and it is a great way to hear from other great NICU RNs.

[LilPeanut, MSN, RN, NP]

I don't know our policy on micros - but pretty much other kids are q3hs for vitals. Full on assessments are done whenever the nurse changes, so either 8 or 12. vitals/care for us is BP, apical, resprs, girth and diaper. Every kid gets girths regularly. Some nurses will skip the q3 bp, if babe is older and stable. They'll just do it q8h, esp if babe is a cranky one.

NPO/Belly babies are q4h technically, but in reality, it's when they're awake. If they're sleeping, don't you dare touch them. *LOL* All kids have temp probes on, so temps auto cross over to the comps.

[RainDreamer, BSN, RN]

We do monitor VS q1h, for all the kids.

NPO kids are q6. PO feeds are q3 or q4 and we do a hands on assessment at that time. For the feeders/growers we usually feed q3-4, but just do an assessment every other round. The in between rounds we just feed, change diaper, and check a temp. Each round we always take a temp because our temp probes aren't always the most accurate.

So typically the itty bitty babies are q6 unless they're on feeds. The bigger babies that are on feeds are q3-4, unless they're fussy gut or cardiac babies .... then we usually just feed ad lib and mess with them when they're awake only.

[pedrn, RN]

We do full assessments q 12 with vitals, head cir., girth everythingon all babies. On grower feeders we do vitals with feeds only.(unless something abnormal of course). On babies under 02 or on vent its vitals q 2 regardless of npo or if og feeding. Suction if needed etc. We just get vitals, disturb them as little as possible on our sick babies. Change diapers only when necessary.

[Gompers, BSN, RN]

For a really sick baby, Q1H monitor vitals with hands-on vitals Q6H.

For a more stable baby that is NPO, Q2H monitor vitals with hands-on Q4-6H.

For a grower-feeder, it depends on their feedings. Q2H feeders get monitor vitals Q2H and hands-on vitals Q4-6H. Q3H feeders get monitor vitals Q3H and hands-on vitals Q3-6H (I always do Q6H to allow for rest but many of my coworkers bug these kids Q3h ). Q4H feeders are pretty much handled Q4H as they're usually full-term by this time.

Exceptions:

Babies that PO all of their feeds. Of course they'll get woken up for every feed.

Big chronic babies. We'll do monitor vitals on them when they sleep and handle them when they're awake. The very stable ones just get vitals once a shift. Especially trach babies and older gut babies - for these kids we usually bathe and vital them around 9pm, then let them sleep all night and vital them again when they wake up around 6am. We might sneak in for diaper changes if they have sore bottoms, but otherwise if they don't move, we don't touch them. They're usually on continuous feeds so they don't get hungry and sleep all night.

The whole diaper-changing thing seems to be an issue. If I'm handling a baby Q6H, I don't reposition or unswaddle them between handlings to change their dapers. To me, that defeats the purpose of minimal stimulation - they're going to wake up and it will interrupt their sleep. But most of my coworkers will do monitor vitals on a baby yet will wake them up and change their diapers. I prefer to let the babies stay in a deep sleep (which is rare in the NICU) and will just hang their next feeding NG and leave them alone. Then again, I work nights, and I know these kids are bugged all day long by docs, therapists, and visitors. So for my 12 hours, letting the babies rest is my top priority.