NICU questions- a few weeks in

[noodles1987]

Hi, I am a relatively new NICU nurse and have a few questions. I have asked these questions of my various preceptors and often get differing information. I have read through all policies and none are very specific.1. Residuals- when to discard, when to refeed, when to notify MD. I have read through all the residual threads here and there seem to be many varying opinions. what is your rationale for tossing, I worry about removing electrolytes and acid needed to digestion and this seems to be the most common practice in my NICU.2. Thermoregulation- when an infant fails an open crib ( after hitting 1800g and being properly weaned to a 27 degree isolette for at least 8 hours) do you put them back to skin mode, fully undressed and start the process over or can you leave fully dressed in a 27 degree isoletteCan you use a bill blanket in an isolette? What if baby is less than 1800g and has not started weaning process but is consistently hot in an isolette with a blanket or blanket and light?3. Tpn- is acetate added separately by the pharmacist and never ordered by the MD? When checking TPN against an order, this is often not on the physician order but is added to the bag. 4. Pcvl/picc lines- when they are found to be low lines (ex accidentally pulled back during a dressing change) is it still appropriate to do the heparin/Vanco flushes every 12 hoursThank you so much for your help!

[Luckyyou, BSN, RN]

These are all going to be policy-specific questions to your NICU. I can tell you how and why we do some of these things in my unit, but that doesn't make it the right thing to do in YOUR unit. The best person to ask would be your unit educator.

[NicuGal, MSN, RN]

What lucky you said, check hospital standards and policy/procedure. A lot of what we do is nursing driven or unit culture. We use Lippincott for many of our procedures, etc and have it online under references. As for the acetate question, ours is ordered on the TPN orders. Residuals, this varies from place to place. We only hold if greater than half the feed and only check residuals every 4-6h. If it looks icky like a lot if mucus, we pitch, otherwise we feed thru it. Anything green or yellow gets a look by the fellow.

But please, ask your CNS, preceptor or educator what is common where you work.