NICU pearls

Baby Wrangler · Apr 15, 2015

That regression algorithm would definitely be very useful to double check ng tubes! Thanks for sharing that! I'm going to memorize that.

I don't know if I agree with this one though..."From a pain and discomfort perspective THREE venous sticks are still preferable to one heel stick. Learn how to do them. You will also get more accurate lab results." I agree about the more accurate lab results but pain wise, I don't know if this totally applies to prems, but having venous sticks done on your hands (which we mostly do to save bigger veins for PIVs or potential PICCs) is extremely painful for adults. I personally would always do a capillary sample than a venous one unless it requires over a ml of blood or has to be venous.

labordude, BSN, RN · Apr 15, 2015

That regression algorithm would definitely be very useful to double check ng tubes! Thanks for sharing that! I'm going to memorize that.
I don't know if I agree with this one though..."From a pain and discomfort perspective THREE venous sticks are still preferable to one heel stick. Learn how to do them. You will also get more accurate lab results." I agree about the more accurate lab results but pain wise, I don't know if this totally applies to prems, but having venous sticks done on your hands (which we mostly do to save bigger veins for PIVs or potential PICCs) is extremely painful for adults. I personally would always do a capillary sample than a venous one unless it requires over a ml of blood or has to be venous.

This has been validated twice (once in 2007 and again in 2011) using a Cochrane review by Shah and Ohlsson, though the focus was on term neonates. Core Curriculum also discusses this with an additional, though circular reference in Folk(2007) Guide to capillary... I should have been a little clearer, though I do appreciate your viewpoint and input.

tallynurse · Aug 10, 2015

nicuguy-do you do any special positioning with bubble CPAP? I'm a travel NICU nurse about to work at my first hospital using bubble CPAP and was told to research positioning with it but I'm not really finding anything about positioning differently. Also any tips for bubble CPAP in general would be great!

NICUmiiki, DNP, NP · Aug 10, 2015

Get RAM cannulas!

They look like regular cannulas (prongs are slightly bigger), but they can deliver CPAP from a vent. No need for all that head gear nonsense. We even put them on our micro premies once they've gotten their surfactant and extubated. Way easier to position babies with. Just watch out for all the gas in their bellies.

Baby Wrangler · Aug 10, 2015

We have ram cannulas too but I was told by our RTs that because it's less of a seal around the nose it doesn't actually provide the same amount of pressure as the mask cpap. We generally only put our babes that can tolerate a lower cpap pressure on them. That being said, the babies that can tolerate them love them!

NICUmiiki, DNP, NP · Aug 10, 2015

We put all of our babies on them. Even the micros. We don't use the other type at all.

Baby Wrangler · Aug 10, 2015

Do you guys notice any difference between them and the other kind? It would be nice if all our babies that needed cpap could be on RAM. No more nasal breakdown.

NICUmiiki, DNP, NP · Aug 11, 2015

Respiratory difference is negligible. Positioning and head shaping is significantly better as you could imagine.

This is 3rd hand knowledge. I've never used the other type. My preceptor (veteran NICU nurse of 35+ years) loves them and says overall they are much better.

It did shock me the first time I saw a 24 weeker with just something that looked like no more than a nasal cannula.

NicuGal, MSN, RN · Aug 12, 2015

We changed from bubble to RAM about 4 years ago. Kids do great, are more comfortable. If they are in the nose correctly with the right size prongs, they are very comparable to B-CPAP. And much more parent friendly for kangaroo!