skysurfer

Dear Colleagues, i am writing from Switzerland. We do not have such suction devices like the neosucker. We use atraumatic catheters. And here comes my question. Years ago i learned that one can insert a "atraumatic" catheter with applied suction. When i searched the internet and my literature i found no evidence to support that practice. They all seem to insert the catheter and apply suction when pulling back the catheter. Is there a bigger possibility to damage the nasal tissue by applying suction while inserting the catheter? Dont one "pushes" the mucus further down the nose when insertin a catheter without suction? Is there any Literature available which shows a benefit of one ore the other technique? Thanks for your Help. PS i do apply suction when i insert a catheter into an ETT. Just to get the secretions that are within the ETT. But we do not suction deeper as the ETT Tip. So this shouldn`be a problem for damaging the Bronchus...

Dear Colleagues, our unit (Ped/Neonat. ICU) is currently in the process of re- structuring the interdisciplinary teamwork. We like to see our work as a relational triangle between Nurses, Physicians and Patients (& Parents) which can (and should) be optimised. We are focussing on optimising our feedback culture, roles and competencies, decision making, as well as our working procedures. We are searching for a model which focuses on the topics mentioned above. The goals which should be achieved by implementing such a model are: Ø To ensure an outstanding care of our patients & their parents Ø To optimise the interdisciplinary teamwork Ø To bring a flat hierarchy into use Ø To increase communication skills between the disciplines Ø To shorten the decision making process Ø To warrant a higher job satisfaction Ø To rise the climate of reciprocal estimation Ø Responsibility should be carried collectively Ø The model should be adaptable and viable If someone feels that his/her unit reflects and lives the philosophy mentioned above and has a written policy regarding a certain model which could help us to implement it at our unit, please feel free to contact me privately or via this forum. We would like to send someone to your unit "as a spy" to see what the secret of your success is... Thank you for your replies in advance

dear colleagues, our unit (ped/neonat. icu) is currently in the process of re- structuring the interdisciplinary teamwork. we like to see our work as a relational triangle between nurses, physicians and patients (& parents) which can (and should) be optimised. we are focussing on optimising our feedback culture, roles and competencies, decision making, as well as our working procedures. we are searching for a model which focuses on the topics mentioned above. the goals which should be achieved by implementing such a model are: ø to ensure an outstanding care of our patients & their parents ø to optimise the interdisciplinary teamwork ø to bring a flat hierarchy into use ø to increase communication skills between the disciplines ø to shorten the decision making process ø to warrant a higher job satisfaction ø to rise the climate of reciprocal estimation ø responsibility should be carried collectively ø the model should be adaptable and viable if someone feels that his/her unit reflects and lives the philosophy mentioned above and has a written policy regarding a certain model which could help us to implement it at our unit, please feel free to contact me privately or via this forum. we would like to send someone to your unit "as a spy" to see what the secret of your success is...

dear colleagues, our unit (ped/neonat. icu) is currently in the process of re- structuring the interdisciplinary teamwork. we like to see our work as a relational triangle between nurses, physicians and patients (& parents) which can (and should) be optimised. we are focussing on optimising our feedback culture, roles and competencies, decision making, as well as our working procedures. we are searching for a model which focuses on the topics mentioned above. the goals which should be achieved by implementing such a model are: ø to ensure an outstanding care of our patients & their parents ø to optimise the interdisciplinary teamwork ø to bring a flat hierarchy into use ø to increase communication skills between the disciplines ø to shorten the decision making process ø to warrant a higher job satisfaction ø to rise the climate of reciprocal estimation ø responsibility should be carried collectively ø the model should be adaptable and viable if someone feels that his/her unit reflects and lives the philosophy mentioned above and has a written policy regarding a certain model which could help us to implement it at our unit, please feel free to contact me privately or via this forum. we would like to send someone to your unit "as a spy" to see what the secret of your success is...

There is a breakdown of a whole lot of other things, too, if a baby is intubated for months and months....... We usually intubate our infants via nasal airway, simply because it´s tolerated better by the infants and the fixation is more easy and accurate. The infant is still able to train his/her suck-swallow rhythm and can be calmed with a pacifier if necessary. We also administer glucose for painrelief that way. However, in cases where a nasal intubation is not possible, we use the neobar ETT holder for securing the tube. In all other (nasal) cases, we have our very own technique of securing the tube. I would say it´s "bomb-proof" and i have pictures that show how we secure our tubes.http://www.intensivmedicus.de/downloads/Tubusfixation.pdf It is a safe way to intubate, if you´re trained. I´ve been told by a physician that comes from england, that there is a historical reason that in europe we prefer to intubate nasally (only small children) whereas in the english speaking countries they prefer to intubate orally. It is not a common practice for "youngsters"(young physicians) to intubate here in europe. It is only done by experienced residents. In the US,however, it is often performed by RT´s, Nurses or young physicians which are less trained, he said...... For all those who are interested in this, i have an english version also, which i could mail to you privately... cheers Norbert aka Skysurfer

Cheers everybody, i am a NICU Nurse from Switzerland and i am planning to work in the USA. In Switzerland we have 9 hour shifts, whereas in germany where i worked befor i moved to switzerland, we had shifts that lasted 7.45 hours. I am wondering how long a NICU shift in the USA is? I heard about shifts that would last up to 12 hours:uhoh3: .....isn´t that tough on a busy NICU? How can you stay Focussed and concentrated about such a long period of time? Isn´t that related to more incidents and errors? Sky

If you´d copy the document to your desctop, you should be able to fill out the Qestionnaire and then insert it at your Email program to send it to me...i just tried it. Hospital / Unit: SaO2 Limits in Preemies Upper Limit: Lower Limit: Monitor: Do you stimulate : Brady´s? Apnea? Brady/Apnea At which value do you stimulate the Infant? SaO2 of: 80% 70% 60% 50% 40% 35% How many sec. Do you usually wait before you stimulate the Infant? When do you start using O2 ? SaO2 of: 80% 70% 60% 50% 40% 35% How muchl O2 is used? 10% more 20% more 50% more 100% more How fast? In seconds or minutes: When do you start bagging the Infant (Mask/Ambi bag)? SaO2 60% 50% 40% 35% HF (bpm.) 60 50 40 35 Do you have a fixed Practice Guideline? Yes No Do you have an„unofficial" guideline? Is Practice in this case individual / „intuitive"? i´d appreciate your answers, and if you write your e-mail adress i would let you know about the results we are hoping to find.... thx in advance Sky

Hello out there, As everybody can see, my post was read about 88 times by different People, but i havent received a single questionnaire..... What´s the problem? are there no Nurses that can answer the questions? Don´t they want to? Too much work? Can someone please tell my why there is no response to my questionnaire? thx Sky

Stone age? if you´d knew how many different treatment options are available and have been shown as effective, but no one cares about them, for various reasons........ Yo cant be a bad nurse, because you can tell your colleagues about the use of sucrose now:) . We also do this things you mentioned above, and we also have few people that dont use sucrose or glucose the way they should or could.....one has to remind himself of the option that we have by using oral sucrose/glucose. It is little work but great benefit for the patient........

Bucher et al 1995 showed in a study that sucrose in such small doses has not been shown to cause hyperglycemia.....:thankya: In intubated children i´d bee very careful because of possible aspiration of the fluid.

Hello cajrio, We are using sucrose(glucose 20%) for pain relief in Infants 0-1yrs. The Infant has to be on enteral feeding, has to have a normal sucking behaviour, and a normal sip reflex. Contraindications are as follows: NEC, confirmed or estimated Sedated or relaxed child No enteral feeding No suck or sip reflexes Severely ill child, intubated and ventilated, as the sucrose is only given for small interventions like IV-Line placement, Heel Stick, small interventions like removing tapes on skin etc. Severely ill children have to receive pain treatment with other, stronger medications.The maximum ammount of glucose administered per intervention is ruled by the childs weight as follows: 1.500 – 2.500g: 3x 0.4 ml > 2.500g: 3x 0.6 ml We haven´t noticed an increasing number of NEC in our Unit. Numbers are stable since we first introduced this system. The glucose is applied by a small syringe at the front part of the tongue and then, a pacifier is given, because there is evidence that sucking reduces stress......Giving glucose is under authority of the RN´s. If reached the maximum dosage for the childs weight, we go on with other Medications like Nubain....Paracetamol... for further information pls see http://www.medscape.com/viewarticle/458592 hope that helps

Hello From Switzerland, We don´t intubate at our Unit, we dont have RT´s, so the intubation is done by our Physicians. But we perform BGA´s interpret them and do Vent changes. In our post graduate intensive care course, which takes 2 years to graduate, we are well trained do to respiratory care like when to choose the right vent setting or mode. We don´t interpret X-Ray´s, sometimes we do interpret them together with an MD, but only if you´re interested in doing so. So you can but you dont have to......Difficult cases are treated by a RN with special license in intesive care mentioned above,(All RN´s in our Unit have to have this license....) and an MD together. That means that the goals are set together, but the changes and the evaluation then is made by a Nurse......

Just visit the following websites http://www.sccm.org/specialties/pediatric/picu_course/index.asp http://pedsccm.wustl.edu/Clinical_resources.html hope that helps

Hello everybody, We (Eastern Swiss Childrenshospital St.Gallen) have developed a questionnaire to collect information over the optimal use/current practice of using O2 and SaO2 in preterm Infants with bradycardia/apnea syndrome. There exists a considerable body of literature on this theme, but little relevant information regarding optimal practice in the clinical setting. Therefore we are asking for help from other Units in Europe, UK and the USA to provide information regarding their practice in this area. I would be very grateful if you could share your practice. I would be particularly interested to hear from the staff who are actually involved in treating this syndrome. Reply´s can be treated confidentially and all interested Units will be informed of the results and accredited as necessary should publication follow. You can download the questionnaire here http://www.intensivmedicus.de/downloads/vortraege_skripte/practice_guideline_sao2.doc Replies, comments or enquiries can be send to the Practice Group of the NICU which you can reach by sending an email to: [email protected] Thank you all in advance. Sky

I was in the middle of the my Nursing education, when i saw a documentation on TV about Preemies. That´s when i knew once i will work on such a Unit. I did a practicum during my last semester where i had to do it in my vacation time, cause in our school we weren´t able to earn such experiences. So i went to a Childrens Hospital where i had the first contact to these tiny little Human beeings. I finished Nursing school and started working on a ICU for Adults, got my licencen in Intensive Care Nursing and then went to a NICU. So here i am, where i wanted to be.