Mofe'ny

What about switching to all syringe pumps? That is what we did and it is SO much easier. Not only for buretrol issues, since the pump will alarm when the syringe is near empty, but priming fluids and adjusting drip rates are now simplified. We love our suringe pumps and have finally rid the unit of all of our old tubing and pumps. It took about 2 years to fully convert though- without needing the extra pumps as backup. I can PM you the name of our brand of pumps if you are interested.

We don't use lemon swabs either. Normally just gauze and H2O then some Sweet-ese if it is a fussy kid.

Yes, that is how we do it.

((((((((((HUGS))))))))) Hope they are both feeling better. Try to get some sleep--- that normally helps too.

6 x wt in Kilograms x desired dose in mcg/kg/min divided by desired amount of fluid ml/hr equals mg of dopamine to add per 100 ml of solution The STABLE program recommends this for dopamine calculations, and references this to the NRP program. Instead of 6, we use 3 and add that amount (mg) to equal 50 ml and run on syringe pump. We use this formula for dopamine and dobutamine calculations.

Family members (normally Grandmothers) that ask 5 times how long the baby is--- while I am trying to make sure the baby has a 5 minute apgar of more than 2. Then they get upset that you haven't measured them yet. The younger the baby's gestational age/ sicker they are, the sooner they ask. OB Docs that want you to assign a 5 minute apgar before the baby is 5 minutes old, or call and chew you out because 'he looked OK to me'. "Well, Since the baby was in the NICU at 5 minutes old on the ventilator with 60% sats, I don't agree with the apgar of 10 that you gave."

Ok, Maybe this will help. I just read about this the other night. I am quotingfrom "Neonatology: Management, Procedures, on- call Problems, Diseases and Drugs" 5th edition by Tricia Lacy Gomella page128 "Several methods are currently being recommended for indomethacin therapy. ... The first is the originally described method of 3 doses being given at 12-h intervals. The second method uses the same total dosage but prolongs the indomethacin treatment over a 5 - 7 day treatment period. A third method involves a slow infusion rate for each dose given over 20 - 30 min rather than a bolus infusion. This method is believed to have a reduced effect on cerebral blood flow. Finally a fourth method uses continuous infusion. This approach is considered to have less effect for renal vasoconstriction and less PDA recurrence. Continuous IV indomethacin infusion is given at 11 ug/kg/hr for a total of 36 hours (the same total dose as for other types of infusions). The continuous infusion appears to lessen the prolblem of decreases cerebral blood flow." At my unit we do the Q 12 hour doses X 3 doses. I think we also run our flush over 30 minutes like Gompers.

We run all feeds on a pump over 30 minutes unless otherwise specified. We also use silastic tubes, that, according to policy, can stay for 30 days. I have never seen one last that long before it got pulled out. Another question- the textbook that Tiki quoted said something about burping the baby at the end of the NG feed. I have never done this or even heard that this should be done. I was taught that with NG feeds there isn't air swallowed, so no need to burp. So, do you burp your babies after the NG feed, or did I read that post wrong?

We also double check all meds and co-sign the MAR of any drugs that we mix. Pharmacy mixed meds do not have to be co-signed. This policy changed within the last two years. We are not allowed to do any K-- only the doc or NNP's can mix that. Our med error rate has dropped significantly since we started double-checking all meds. Of course, we have a small unit, so this might not work everywhere else.

We've been using CRP's for about 6 months or so with admissions. At the ANN conference in Vegas I heard that when doing a CRP on a baby less than 24 hours old, it could be positive due to maternal factors. I am now trying to find documentation of this because when I talked to the speaker afterwards, she was kind of vague about her sources for that information. I haven't been able to find it on the internet anywhere and our neonatologist hasn't come across any info about it yet either. Also, how many of you are using CRP's?

Whoa, we had our survey mid february. Guess what! WE have a selfinking stamp that says, "Read back and verified, _______________ RN / LPN" And with several doctors we have been told to have 2 people on the phone when taking any orders from these few doctors because they have a habit of denying the orders in the AM.

Wow I just read this thread again for the first time in months. Just wanted to pass on some encouragement to those of you still struggling with IV's. For me it seemed that once I was able to get a few IV start in a row, I haven't really had much trouble with them. I'm not intimidated by IV's anymore!! So it does get easier with practice!!! :)

Nicugal, I will have to look & see who makes our 5 FR silicone tubes. I work again Saturday night, so will try to look then.

In our unit we use the 5 fr silicone feeding tubes, that can stay in for a 30 days. We normally do NG feeds, but our neo is wanting to switch to all OG feeds. The nursing staff has fought this because it seems that the babies pull out the tubes less with NG. We do not feed babies on vents or NCPAP because they are normally not on them that long. If a baby is on a vent longer than 4-5 days we ship to the Level 3, due to our NP and Neo staffing. (we are a small level 2 without 24 hour in house NNPs unless we have a vent baby) Babies on NCPAP all get an OGT open to air. We hang all of our feeds on pumps over 30 - 60 minutes, depending on how the baby tolerates. Normally that is nursing judgment, but sometimes is ordered over an hour. The babies are fed on different "schedules" Q 3 hours, we also do all cluster care with feeds. We don't have to stay at the bedside, but there are normally 2 RN's within a few feet of the baby.

Handbook of Neonatal Intensive Care by Gerald Merenstein and Sandra Garner Check out the thread titled Recommended reading for NICU or something like that. It is on the 2nd or 3rd page, but gives a lot of good resources. I have the book "Preeemies" and although it is written for parents it is very easy to understand. I read it when I first started NICU and it also helped me to communicate with thh parents more. It is also listed in that thread. I would post the link to the thread, but I don't know how. IMHO means In My Humble Opinion :imbar Well, guess premrns and I were posting at the same time!