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!

Hi, Yes we do decorate, but mainly the non patient care areas. We have a central nurses station that we decorate and put up a small tabletop tree (with no lights!!!!) We made construction paper ornaments (snowflakes, candy canes,stars) and put up the discharge pictures from babies born that year, as well as some of the 'graduates' christmas pictures that some moms will send us. We also have little stockings for the babies, that we will put out on christmas eve. I am going to check with the parents of the babies that are there at Christmas this year to see if they celebrate. I bought some packages of personalize-able ornaments--- mainly snowmen-- nothing offensive, and will write each babies name on them for their stockings. Parents seem to love keepsake stuff! Our unit has a lot of curtained windows and we are surrounded by hallways going to L&D. So last year we put window clings on all of the window. Something else neat that you can do is put a window cling on the outside of a babies incubator. You can normally find them at walmart for about $1.00 / card.... and you can use one card with different things on it for several babies. Then we give them to the parents to take home for baby books if they want them. Otherwise they get trashed when baby goes home. For fall/thanksgiving I found cardinals sitting on fall branches. Does anyone else have some ideas for inexpensive decorations? we would love to decorate more, but most of our stuff is old & ugly, except for what several of us on night shift bought last year after trying to decorate one night, and realizing how awful our decorations looked. Do you put lights on your tree? We can't due to fire hazard. That is the only stipulation that we had.

Well, I also heard that he left the OR when th OB started cutting to tell the family that he couldn't put mom under due to his bent key. when the CRNA got up there from the main OR and they put mom under---- the CRNA straightened his key out and it would work!!!!!! They also charted all of this in the pt.'s chart, as well as what else was happening in the main OR's with which other doctors and that it "was a very busy night" Oh my gosh I am so glad I wasn't there!!! Rish management will have a fit over that chart don't ya think! There are about 8 incident reports filed on that case, because the OB doctor was pushing anesthesia around and throwing instruments after the section. By the way this mom was WALKING to the nursery to pick up the baby by the next night!!!! The other local section was an abruption after mom was pushing for an hour. They had called a section for CPD when they lost FHT completely and mom started hemorrhaging. I think that one was 8 minutes from loss to admission to the NICU. Baby did OK on that one too. Too scary though.

Respiratory is normally prett good for us, it is the hospital pharmacy. TID AC is to them 0730, 1130, and 1730 or something like that, for say reglan or something. Guess the baby is going to just reflux all night long. Whatever, we just have to fix our MARS when they print them up. I still think that you should try to get some inservices done on developmental care for the resp. dept. We had to do that with PT, and respiratory and it has really helped.

Just wondering if this happens at other hospitals. I work WBN & NICU, so I don't understand all L& D ! We had a crash section the other night with mom only having a local anesthetic!!!!!:imbar I wasn't working (Thank Goodness). But I understand that anesthesia couldn't get to the meds because his key was bent. FHR had dropped to the 40's, and the baby was born 12 min. after it dropped. The baby was just transitioned with O2 hood, and ended up going to WBN the next day! This is the 2nd section under local in the 2 & 1/2 years that I've worked here. We do about 800 deliveries a year. does this happen anywhere else???!!!

BID in our NICU is Q 12 hours. We have fought with pharmacy and respiratory about this too. Our neo & peds told them that Babies are different!!!! We schedule resp. treatments around feeding / Hands on times. Sounds to me like your respiratory dept. needs education about developmental care.

Thanks memphispanda. Glad to know I am not completely losing it! I think it is awful though.

Will someone please tell me I am not crazy? The other morning on my way home from work, I was listening to the Today show on the radio, and They were talking about a CRNA and MD being investigated for reusing needles. This happened in the Midwest I think. Anyway there have been about 50 cases of Hepatitis linked to patients of "this nurse". No one that I worked with the other night had heard about this, and I am starting to think that maybe i was in a fog driving home after working a 12 hour shift. I remember this because they also had a lawyer on the show who is getting a lawsuit ready against the hospital, etc... His comment that irritated me was that the hospital had a duty to account for all the needles that were used. While I am sure there is a lot more to the story, How do you account for every needle in a hospital? Any feedback on this story... or was I dreaming on my way home?????

I have a ? about ID bands. What happens when your micropreemies "outgrow " their bands? do you reband them? i have seen them taped on at our NICU and Just wondered if this was OK.

Help! How many times do you all try to start an IV on a baby? I get so frustrated sometimes. We will normallly try a total of 4 - 6 times(different staff RN's) before calling the NP's. I was ready to cry this morning when I left work, because after we had attempted 5 sticks, I called the NP. She came in to start the IV and I lost count of how many times she tried. I had to give report and the day shift nurse started helping her. Does anyone have any tips on starting IV's? WE could get flashback, but the catheter would not advance, the vein would blow. This is a term baby with pneumonia, so I am sure she will be on at least 10 day's of antibiotics and she is only 3 days old! Also, do you use saphenous or Antecubitals? Do you use transilluminators when you start IV's?