Knocking on isolette

[Super RT]

I recently witnessed a nurse knocking on the outside of an isolette when a baby was having an apnea/brady spell. She did this multiple times durring the shift. This was a very small preemie. Wouldn't this maybe increase the baby's stress level, possibly leading to IVH?

[Katnip, RN]

I never worked in a NICU, but every time I've shadowed, they do the same thing. I think they're more concerned about getting the baby breathing. I would think just about anything else you would do would cause stress anyway.

[Jolie, BSN]

This is not an appropriate way of relieving an apneic episode. Gentle tactile stimulation is far preferable, and better for the baby.

Exposure to unnecessary noise is never desirable, especially for micro-preemies. (And sound is "magnified" inside an isolette.)

If a nurse notices an apneic episode that is not being self-corrected, and has dirty or full hands, it may be necessary to tap on the isolette, for lack of other options. But it should never be the routine method of relieving apnea.

[SteveNNP, MSN, NP]

I agree with JOLIE.......knocking doesn't solve the problem. often the baby needs something else, like additional respiratory support, repositioning, or tactile stimulation. I bet the baby's BP went through the roof every time she did that, iincreasing the risk of IVH. Personally, if I saw her continue this, I would go to the nurse manager or charge nurse and let them know......

[Super RT]

I agree with JOLIE.......knocking doesn't solve the problem. often the baby needs something else, like additional respiratory support, repositioning, or tactile stimulation. I bet the baby's BP went through the roof every time she did that, iincreasing the risk of IVH. Personally, if I saw her continue this, I would go to the nurse manager or charge nurse and let them know......

That was my thought! They always tell you not to tap on the glass of a fish tank bacause it stresses the fish. I would imagine that the baby was even more stressed than the fish would be!

The problem with telling the nurse manager is that this nurse and I have tangled majorly recently. I'm afraid that if I went to the NM, it would just appear that I was trying to get her in trouble to pay her back. I guess I should just watch her and if she does it again, I should report it then. Hopefully she wont do it again.

[fergus51]

I agree this isn't the best method. Unless your hands are filthy and you can't clean them fast enough or something, then it's best to get the baby's hr up even if it means tapping on the isolette. I doubt this would be a real risk factor for IVH though, since the BP will usually shoot up even with gentle tactile stimulation.

[rainbows4me]

I have to agree, that while it's not my first choice, i've done it many times. Last night, in fact, I was forced to as well! When your hands are dirty and you see a brady to the 50s, sat in the 60s and flat line in the resp monitor, you do what you need to do. I think you might do yourself some harm by reporting this - I know in my unit it'd come accross as trying to stir up trouble. I'm not saying this should be your standard of care for an ABD episode, but sometimes it is necessary to buy time until you can wash your hands and get into that bed or wait for someone who is clean to get to the bedside.

[sparkyRN]

Totally agree with rainbows. While it's not the preferred or best form of stimulation, if your hands are dirty a thump on the isolette will create a startle relfex and a deep inspiration. If my hands are dirty and the ABD is severe, I'll thump the isolette with my elbow and grab a can of alcohol foam. Even if the baby takes just one breath, it buys those few extra seconds to get my hands clean so I can deal with the baby.