krenee

We had 3 sets of 22 week twins last summer. One of each passed away and the other survived. One I honestly don't remember the outcome, one was a pretty poor outcome but survived. The third survived amazingly well. Either no or grade 1 head bleeds, no or minimal ROP. Went home on a cannula and is still on a cannula at 14 months but not much flow. She's crawling and smiles and seems sharp. She was a definite 22 weeker because she was IVF. She honestly changed my mind about resuscitating 22 weekers. Now I say give them a chance. See how they come out.

Our central line changes are allegedly sterile, but since it's not a two-person system, it's really half-sterile, half-clean.

I've worked in three NICUs of various levels, and for none of them was it a big deal to open the top. I do it rarely, but I don't think anything about it if it would make it easier to reposition an intubated kid or start an IV or something. And never would we put in a central line or intubate with the top down. There is a heat source, I don't see this as a tragedy if it's open for a bit.

What do you even mean, 21 weeker? I've never seen one alive. Wow.

What do you even mean, 21 weeker? I've never seen one alive! Wow.

Actually I still get notices via email when someone posts on my thread. My vacation was not approved, and I didn't go. I barely got so much as an apology. Basically I could have called out & taken my chances, but I had just recently started working in the NICU there and didn't think I'd get hired in another NICU without more experience. So I switched my cruise to the following spring break. If I had been in a better position professionally I might have gone anyway & taken my chances, but you'd have to be prepared that you can lose your job over it.

No, we don't do surgery or cooling, we ship them out. I'll get 8 weeks I'm told.

So I've now had experience in level II, and almost two years in level III. Just got hired in a level IV. When I went from II to III I had a rough transition - basically felt like I knew nothing and even the kids I thought I was capable to take care of, I sucked at. So I'm nervous . . . my question is, how hard of a transition should I expect? I know micropreemies now, but not surgical, nitric, or cooling. And I'm basically expecting more sick babies since this is the hospital they get shipped to from all around.

Are you sleeping in the daytime? I work nights and I work 60 hours a week . . . everyone wants to know how I do it, and I tell them I sleep! 7-8 hours a day. I don't do anything when I work except eat, sleep, and go back to work. I also have a very understanding dh! If you need tips to sleep in the daytime, I have plenty. Good luck!

I wish someone would do a study on whether the health risks of night shift still apply if one gets enough sleep. I hear all the scary stories about cancer, etc. due to shift work, but I wonder how much of that is due to sleep deprivation. I sleep very well and work nights and I feel fine . . . although I do hate that first day off!

We had a 23 weeker recently, and on his first day of life, his mom asked me, when will they feed him, and when can he come out of the isolette? Um, you mean IF he lives??? The circ question drives me crazy . . . when are you going to circ him? I always feel like they're worried we won't. Before discharge, absolutely. And the blood type question . . . I want to know why non-medical people are so worried about the blood type? Heck, I can't even remember my own blood type, much less my kids'.

My first NEC case was recently as well . . . ex 26 weeker who was 40 days old, on full feeds and had never had any problems tolerating the feeds. I'd had her many times before. First hands on she was fine. Second hands on she had had some emesis, fairly large residual (about half her feed), and increased girth and questionably firm abdomen. I called the Dr, she was made NPO and we drew labs & got a KUB, which the Dr. thought looked OK. Her CRP came back 14 so we started triple antibiotics. Her H&H were low, her platelets were 26. Next hands on her girth was increased and abdomen definitely firm, I got about a 9 cc residual of brown yuckiness, and there was stool with blood. Drew more labs, and her K+ was high, her Sodium was low. Her output was about nothing. She was a sick little baby . . . She got platelets & then rbcs, follow up KUB and shipped out to a higher level NICU because we don't do surgery. It was amazing to me how she went from "fine" to critical over a 12 hr shift. I did, however, felt like I did everything right . . . let the Dr. know as soon as she was questionable. Word is she's doing OK. NEC is scary!

I do stay up the night before my first night shift . . . I used to do housework when I was new and ambitious . Now I mostly catch up on my TV shows! I do usually go to the gym around 10pm and the grocery store at 11pm because they close at midnight. So by the time I finish with all that it's pretty late anyway.

I got in trouble at work over a facebook post. And yes, my page is very private, and yes it was a co-worker "friend" who ratted me out (she's now BLOCKED on my facebook). My post was referencing something I was really ticked at my manager about, and it was VERY vague - didn't say my manager, didn't even say work, and could have been interpreted a million ways, so I don't think they could have fired me if they had pursued it. However - lesson learned, and my relationship with my manager will never be the same. It's sad we have to censor ourselves so carefully in this lawsuit-happy age. Anyway - I never heeded the warnings because "my page is private". Lesson learned the hard way!

I work at two hospitals. First one is a smaller level II NICU and the RNs get 2 sticks apiece. There are usually only two RNs working. Then we call the NNP. There doesn't appear to be a rule about how many times the NNP can try, and I've seen kids get stuck WAY too many times. PICCs are greatly under-used in this NICU in my opinion. My other hospital is a level III and when I asked how many tries we get, I was told "until we get it". PICCs also under-used in this facility. But the RNs seem to be better at it, probably due to the micro-preemies and such that we get, so the kids don't as often seem to be "tortured". I think it's a good idea to come up with a policy and I may suggest it myself.

I just reached my 2 yrs of experience. Thanks for the information, looking it up now!

Try the advanced practice board . . . I'm pretty sure there's a board for NPs who can answer some of your questions.

I just went from a level II nicu to a level III and just experienced my first death of one of my patients . . . actually she wasn't my patient when she passed, but I had taken care of her. I agree with the above poster who said it can be a relief. We knew she was going to die and near the end, it was so hard to take care of her as we didn't feel like we were helping her, more like torturing her for 12 hrs. I was glad when the decision was made to take her off the vent, and it was the right decision. But I still cried, because is it sad. I'm sure more experienced nurses have better answers to your question, but I can tell you from my first one, you can survive it. It didn't make me want to quit, I want to help the babies that I can.

So from looking online, it seems like you just take the certification exam and pass. But how do you prepare for the exam? Any online courses or study guides you recommend? How long should I plan to prepare for the exam? Thanks!

Thank you. I will certainly be more careful. I called to check on the baby last night & the arm is ok. I am also having trouble leaving work at work! I worry about the babies, I worry about what I might have forgotten. It doesn't help that I'm working two jobs. So few days off to recover.

I have recently started working in a level 3 NICU after about a year & a half in a level 2. I've made a few mistakes lately . . . Not med errors but not catching things I should have. For example last night my IV infiltrated, it was TPN & I'm very concerned about tissue damage. It was a new IV & the pump wasn't alarming resistance. Anyway I'm just feeling today like this is so much responsibility & maybe I'm just not up to it. Anyone else feel this way & get past it? There really was never anything else I wanted to do but NICU & I feel so lucky to be able to, but I don't want to be the cause of harm for these little ones :-(.

To work night shift at Fairfax you'd have to leave about an hour ahead of time. Day shift would be at least an hour & a half. I think the absolute closest to you would be Potomac (which is now Sentara Northern Virginia Medical Center) but that's a small community hospital, basically.

Thanks! Baby is on continuous feeds. Pretty sure there was no PDA but I will have to double check when I get back to work. Thanks for the input!

Yes, I generally ignore the fluctuations unless the kid stays down. My point is only that the sats fluctuate very quickly and by large numbers. Most babies I care for change their sats much more slowly unless they brady.

Hi all! I am new to level III NICU nursing so also new to taking care of micropreemies. Took care of an ex-25 weeker the other day (now 29 wks) on NCPAP. I have never seen such wildly fluctuating O2 sats as this child, and it makes it so difficult to titrate the FiO2. I mean this kid will to within 10 seconds to the 30s, 50s, 70s, 90s. I'm not exaggerating. My question is, how is this even possible? It just seems like it can't be correct, but it's all the information we have to work with. Of course we rely on gases to know the infant's status, but they are only done every 24 hrs. Any knowledge or even opinions? Thanks!