wee one rn

Thanks for the replies! Another question for you all, are the zflos patient specific or are you cleaning and reusing them between patients? Do you have a system for tracking and/or charging for them? Thanks!

Hello all! I have briefly used Z-flo at a prior job, remember loving it, but thought that we could xray through them? I know the company has to say no simply because they didn't test it, but I thought the rep mentioned some units doing it. They just arrived in my current unit and I'm trying to teach people how to use them, you all know how much nurses like change;) Any info that you might have would be greatly appreciated, if someone else is doing it then I can take that info to the powers that be and at least have someone look into it.

We recently had one on a kiddo that had a very bad infection around his umbilical cord. It spread to his entire abdomen and he ended up as sick as could be. Last time I saw him, he was PO feeding and almost closed.

Here's how I've always thought of CPAP, I've worked mainly with the 'vent' CPAP and a little bit with the bubble. The main purpose is to provide a continuous flow of air that causes some pressure in the lungs to help keep the alveoli from collapsing as the baby breathes. The higher the PEEP, the more pressure in the lungs. So, a baby is on a CPAP of 5, which means you will see on your vent a set PEEP of 5. Usually I've seen PEEPs set from 4-6 depending on how bad the baby's lungs are. Now, back-up rates. Sometimes, the baby is still having apneas and needs a little bit more stim to help them remember to breath, or maybe there is a little bit of collapse and they need slightly higher pressures. I've seen this done in a couple of different ways. #1- the rate is set to 10 and pressures are 8/5. This means that the baby is getting a PEEP of 5 all the time, and 10 times a minute the PEEP is increased to 8 for a short period of time. (I have no idea how long, I'll have to check with my RT next time I work, or maybe one of the other nurses can fill that in) This will help to expand the lungs a little more and for some babies that extra flow and pressure is enough to help remind them to breath more regularly. Theoretically, that small increase in PEEP isn't enough to force the baby to take a breath. I've seen backup rates generally set from 5-25. #2- The other way that I have seen backup rates set is more similar to a PIP on a vent for an intubated baby with pressures of 15-20 which will actually cause the baby to take a breath, not simply increase the PEEP. In this case, the babies also generally have pressure support on so that when the vent senses that the baby is taking a breath, the pressure will increase from the PEEP to whatever the pressure support is. IE- Rate-20, PIP-18, PEEP-6, Pressure Support-10. So, this baby will always have a pressure of 6, 20 times a minute the vent will force him to take a breath and give him a pressure of 18(PIP) and for every breath above the 20/minute, the vent will sense the breath and help him with it by giving the pressure support of 10. The bubble CPAP I can't explain the details of, but basically the baby is getting a continuous PEEP of whatever you set it to, I've only seen it set at 5 or 6. Whew! That was a lot and I just got home from a night shift so I hope that it made sense and helped! If anyone else can expand or clarify please do, hopefully someone can explain the theory behind why the bubble is better than the straight flow of mechanical CPAP.

Why hasn't anyone invented canula tubing with prongs/masks that will work with CPAP?? One thing that I have found to work is to use a beanbag under the head. If the baby is on his/her tummy, lay the head on the beanbag to see where the tubing falls and then use your hand to create a groove for the tubing to sit in. That way the head is supported around the tubing, but the tubing isn't squished into the side of the head. I hope that made some sense, and remember: positioning will get easier with experience and before you know it you'll be posting hints for someone else. PS- We use the vapotherms like crazy, I haven't seen any problems with infection from them, but it seems to take a long time to wean off of them...

Hello! I will be moving to the Bay Area this summer and I was wondering if anyone knows names and contact info for the nursing recruiters for UCSF Childrens hospital and/or Lucile Packard. I am looking to work in a Neonatal ICU so if anyone has the names and contact info for the managers of the units that I could contact directly that would also be greatly appreciated! Thanks!! PS- please feel free to PM me if you don't want to post the info here.

I think I used the same setup that Steve mentioned, Infant Flow made by Viasys. Here's a link to the site: http://www.viasyshealthcare.com/prod_serv/prodDetail.aspx?config=ps_prodDtl&prodID=197 Hope this helps!

I've worked in 2 level III/IV units (both do ECMO) and the only kids that get tested are the ones that we think have it. One unit has L&D and accepts transports and hyperbili kids from home as long as they are reaching transfusion level. The other is a Peds hospital that accepts transfers and kids from home up to 30 days old.

Thanks for all of the responses! Here's the reasoning behind it: Lipids are light sensitive, over 24 hours there is an amount of hyperperoxides that are formed and when the baby is under phototherapy that amount increases by 60%. The recommendations that I've found are dark tubing or simply covering the lipids with foil to block them from the light. (Here's a link to Neonatal Network with a blurb about why hyperperoxides aren't good for our babes: http://www.neonatalnetwork.com/nn3/Abstracts/NNmarch01.htm) One thing I haven't heard of is the DEHP tubing. Does that refer to the dark tubing or something else? Once again, thanks for all the input!

Hello all! One hospital that I worked at covered lipid tubing with aluminum foil when a baby was under phototherapy and another didn't, so I'm wondering what everyone else does. All input will be greatly appreciated! Thanks :nuke:

:welcome: That isn't a dumb question at all, it's very good that you are concerned about an adequate orientation. I started as a new grad in a Level III/IV (we do everything including ECMO) and didn't have any problems, I had a 12 week orientation. I had a little extra experience with term newborns from nursing school (I did my practicum in post partum) and that was helpful because then you do know and are comfortable with the 'norms'. Frequently in the NICU parents are concerned about every little startle. I've found it very helpful to be able to reassure them that it is a normal newborn reflex. One thing to keep track of though, how long will you be orienting in the nursery and then how long will you have in the Level III portion? Keep us updated on how it's going!

Everything that you said is normal, that's why we get more than 3 weeks of orientation. I wish there was a magic number to give you, but unfortunately it doesn't work that way. Try not to stress over it, the more you do things the faster and more comfortable you will become and before you know, things will be second nature and you'll be the nurse that the new grads are watching. PS- hearing the alarms is normal, the thing that I hate is waking up at home and thinking that I slept through all of my feeds!

:welcome: There have been several threads on this topic, try a search and you should find lots of information.

One new thing that we recently got is called Z-flo. It's very hard for me to describe, but it is an amazing and unique positioning product that could replace everything else, except for Freddie the Frog, he simply can't be replaced.

We use betadine only, no alcohol, and we do drsg changes every 5 days and prn. It seems to work well, I haven't seen any real skin issues unless the baby had skin problems before the line was placed.