did I make the wrong decision??? allowing a parent to hold

[wnydapoo]

Today I split an extra shift with another nurse because my former 24wk primary who is now 36wks was extubated for the 5th time. He has failed the four other times. As soon as the tube was pulled he became very aggitated. I tried positioning, warm blankets, passifiers, containment, just leaving him alone but nothing helped and his heart rate was well over 200. I obtained an order for a half dose of versed and an hour latter he was screaming again. I managed to hold him off for annother hour and got an order to repeat the dose of versed. The sedond dose only lasted a half hour. After exhaustin all options for soothing I asked the nnp if I should try letting the mother hold. She agreed that crying in his issolette agitated was doing no good so to let the mother hold. I gave him to his mother and he calmed down right away and stayed that way untill I was done giving report to the nurse I split the shift with, which was almost an hour and a half. We decided at that point to let the mother have a break and the oncoming nurse would do an assessement, give a dose of decadron that was due and get him settled down again. The mother went to pump and said she would return to see if he needed to be held again. He remained aggitated through the assesment and we gave him back to the mother at which point he lost his iv. I told annother nurse that he lost his iv and she told me that we have got to stop with the holding and he is not going to make it.

[Jolie, BSN]

You are to be applauded for advocating for that precious baby and mother, allowing them an opportunity for physical closeness and bonding that they have been seriously deprived of. Does your co-worker really think that his IV would have been safer with him thrashing about the isolette?

Please don't take my response as an attack on anyone (although I would like to choke your co-worker for making such a stupid accusation). This is a hot-button topic for me.

My first job as a new grad was in a large and very well-respected NICU in Chicago. I worked there (happily) for 2-1/2 years unti lhubby was transferred to another mid-western city, where I was hired into the only NICU in town. I quickly came to realize that I was working in an entirely different world. Virtually everything I had been taught or learned in Chicago was frowned upon in the new NICU. Treatment protocols were vastly different. Nursing was not respected by the physicians or hospital administration. Nurses did not think or act independently, even in areas of care such as growth and development that were better suited to nursing intervention and ignored by medicine.

One day, shortly after completing orientation, I was assigned to a baby with a fatal condition whose parents had been coerced into consenting for surgery for a non-life-threatening "defect". It was no surprise to anyone (other than the parents) that he was not weaning off the ventilator post-operatively. It was beginning to look like the poor child wold die in the NICU without ever having been held by his parents. The mother arrived that day (from the referral hospital) and wanted to hold her baby. In Chicago, we routinely allowed parents to hold their intubated nfants and practice kangaroo care if the baby's condition allowed. It never occurred to me to tell these parents that they couldn't hold their baby, so I got him out of the isolette, taped up his vent tubing, snuggled him up in his adoring parents' arms in a rocking chair, and moved a few beds away to give them some privacy. At that precise moment, a do-gooder nurse who had no reason to be in our room walked in and had a fit that they were holding their intubated baby, grabbed the child from the parents, and practically extubated him jamming him back into the isolette.

Needless to say, she and I had words. What I regret to this day, 20 years later, was that his parents were so fearful that they did not hold him again until he was weaned from the vent, days later. What a pointless waste of precious time.

You did the right thing. The baby's mother and I thank you:)

[iHeartNICU]

I think you absolutely did the right thing. We are supposed to be advocates for our patients anth's exactly what oyu did. Great job!

[dawngloves, BSN, RN]

I dont' understand why he shouldn't have been held.Because he had an IV? That's 75% of our census.

The only babies on our unit that can't be held ar those on an oscillator or with an arterial line.

[preemiex2]

IMHO you did nothing wrong. Having the baby agitated, tachypneic, and tachycardic in the isolette was not doing anyone any good. I'm sure the mother was upset and fearful that he was going to fail extubation once again so having the opportunity to hold and comfort her baby with the chance of keeping him off the vent was most likely very empowering to her. I work in a level III NICU with a subspecialty unit for chronic BPD babies who are long term vent/NCPAP dependent. We advocate for family involvement in most aspects of care and development and thankfully have a MD/NNP staff who support us fully.

I'm sorry you had such an unfortunate end of shift when you were advocating for your patient and his mother. It is disheartening to have your good intentions and hard work be belittled by a coworker. Keep up the great work for your babies. I hope the little guy is able to stay off the vent soon. One of my primaries is dealing with a similar situation (ex 23 wkr, 44 CA) and just can't kick is vent habit. Our unit uses chloro hydrate for our BPD babies for agitation post-extubation instead of versed. It may be worth a try.

[hikernurse]

Good for you :). The baby was calmer with fewer meds, mom got to hold her baby and feel like she was an integral part of caring for her baby. We encourage kangaroo care even with intubated babies. Our RT's are great at standing by, esp. if the nurse is newer and not yet comfortable with moving the baby on the vent.

The loss of an IV (which never seem to last long with these kids anyway) is a small price to pay.

And you know, if the patient was not going to make it, that is all the more reason to encourage mom to hold her baby.

Jolie, what a sad situation for those parents .

[danissa, LPN, LVN]

You were so right in your actions..well done for bringing comfort to the wee guy AND his Mother! :heartbeat:yeah:

As for your co-worker..words kinda fail me..did she leave her heart at home that day? She sure didn't have one at work with her!

Cuddles should be Encouraged...you achieved something positive at work that day babe! Keep it going!!!!

[KaroSnowQueen, RN]

YOU DID GREAT!!!!

Don't second guess yourself in situations like that. You helped the baby and the mother. it was a great thing for them both.

Your co-worker, well, if she was my co-worker I would have some words for her, beginning with uncompassioniate and anal and probly get worse from there.

[danissa, LPN, LVN]

I read the op again, and that co-worker woman actually said to stop with the holding as he wasn't going to make it????? How is she ever a nurse, isn't that all the more reason to have that wee guy out for cuddles with his parents?

wnydapoo..you did GOOD babe!! Next time she goes off in a flap, take her aside and tell her you are RIGHT! Proud of ya hon!

[viccar82]

I agree. Babies should always be held whenever possible. Thankfully I also work in a level III NICU where our nurses, MD/NNP, and support staff are very supportive of developmentally appropriate care and advocating for the patients and families. Loss of an IV is unfortunate, but holding the baby is best for the baby and family. Keep up the good work:yeah:

[SteveNNP, MSN, NP]

And most likely, that IV was already starting to go before you got him out of the isolette....

[NICUgirl77]

I agree...you did nothing wrong. Babies lose their IV's all the time, it was well worth it to give that mother time with her baby, especially since he has already been there so long!