wensday

Sorry you had such a rubbish day, we've all had babies we struggle to forget for one reason or another. I think as the others have said, you can't presume to know the back story, but it's so hard to look at that little one and feel completely at peace with it. I think when sad or difficult things happen, you have to be hard-faced. You have to push it out. You get better at bringing up that wall. I cry on the way home and then when I get through my front door I try leave it behind. I know someone else is there on NICU doing an amazing job for them. The other thing is remembering the happily ever afters. Those babies you never, ever thought would get out of the front door. Those babies so tiny and fragile or post-op and full of stitches, or suffering from things caused by others- intentionally or otherwise...then seeing them going out of the door all cosy in their 'going home' outfit and smiles and hugs and tears and love. Thats what I push into my mind at the end of the day. The happy. Sometimes it's the only way x

Hi, hope I'm not too late, been away from here for a while. I finished my ANNP MSc last year. The questions for my interview put me in different situations, one about a reg doing something you didn't agree with in the middle of the night, one about speaking to a parent re survival at 24 weeks, umm one about multiple emergencies in different places and managing them with x y and z staff.

Various nappy sizes, tape measure, vest/hat, little doll about the size of a smaller prem. ECG dots and a picture of a little prem with the same dots, for size comparison.

We start with eg 1ml every 2hrs, then go up by 1ml every 8/12/24hrs depending on how small/sick/tolerant the baby is. So a little AEDF/IUGR 24wkr would start on maybe 0.5ml/2h and go up to 1ml/2h 24h later. Yesterday I started a 34wkr on CPAP 2mls/2h, going up by 1ml every 8hrs as resp condition allowed. Once fully fed 2hrly, we go up to 3hourly when we think they can cope with the larger volume.

I reckon I could get an IV in a gigantic vein

This came up recently as mid-transfer an NNP was asked to help at a serious RTA that happened right in front of the ambo, well baby inside with RN looking after it. This is WELL out of my comfort zone after not caring for adults since 2002 and kids since 2004. If you don't fit in an inc, I will struggle bar basic first aid. We get taught up to date BLS but nothing else.

Interesting to hear your perspective as this is my norm :) We've just started e-rostering and most units locally are too. Nurses here do all vent changes as standard, the medics wouldn't have a clue. With feeds, what is the 'q' and how would you do it differently in LA? ta x

Our whole ward wears skechers go walks. They are light as air and are so comfy with memory foam in the sole x

Thanks for your replies, it's really interesting reading the different practice. When I started out all our vented patients were on morphine and midazolam (Versed). Ten years later and we tend to use morphine when they are uncomfortable on the vent and usual comfort measures are failing, or if they are fighting but fail non-invasive. Midaz is rare now although we do use it when struggling. Both we wean as quickly as possible. Nurses get very protective of weaning sedation and argue the decision...pain being preventable. However we (ANNPs/doctors) are thinking about the side effects a bit more. I'm looking at other options because of the risks associated with the above. I'm currently looking at fent and also dexmedetomidine (precedex) research and wondered what everyone else was using. One of our problems is money. The NHS is poor and new drugs are expensive.

Hi I'm a trainee ANNP, 11yrs NICU nurse practice. It all depends on the unit you go to, there is a great variety of acuity and levels. So the NNU I work in is a big tertiary level based in a womens hospital. A tertiary level will vent, HFOV, iNO, pre and post op etc. Level 2/1 will stabilise a sick baby and transfer out to us. Then accept back once well out of the woods and stable- started some feed, time off CPAP, no new sepsis etc. New nurses are on a band 5, onto a band 6 after a couple years experience. This again depends on the hospital, what the band change means, in smaller hospitals it means managing the NNU, our place its managing your room of 5 ITU babies. Payscale- Agenda for Change 2

We use a blood giving set which has a spike and filter within the set, its pretty easy to spike and attach a syringe to, then we unscrew the syringe and push into the baby via whatever access. I've been to a delivery resus once where they couldn't find the giving set quickly and the baby had lost a lot of blood, the nurse really struggled to draw it out of the bag without a spike and it went EVERYWHERE. I can still see the resus trolley with blood in every drawer and all over her.

Thanks, yes we use Vec sometimes too.

Hi all, Do you give your babies sedation for ventilation and if so, what do you give? This is for continuing ventilation, not intubation itself. We give Sux and Fent to tube and then morphine for pain/synchronicity if they aren't going to come off quick. If we are still struggling then midazolam is used. I've read these aren't great drugs but not sure of the alternatives in regular use in nicus. Thanks Debs- trainee ANNP

We use the badger system (UK), all our care is on the computer, monitoring, fluids, blood gases + lab results automatically input to the baby notes then we add our own notes as we go along.

That's really interesting thanks, we tend to transfuse at least one baby each day, at least 10-15 pw I would estimate. This is a 50 bed NNU. We only use EPO for JW babies, with the recent evidence of increased ROP our consultants are wary of it. I know we can sample less that we do, that will be my conclusion.

I would complete an ACE (incident) form every shift. That is how we got out of the same situation. They are a PITA but they worked for us. A form every time staffing is low, every time you don't get your break, every near miss. Honestly it made a huge difference for us and we are nearing BAPM numbers now x

Yep and you have to ask "has anyone seen dad?"

Same with us, we only CXR again if there is an unexpected deterioration and we are considering our options- infection, collapse etc.

This has happened to everyone at some point, so absolutely don't blame yourself! IMO someone should have gone though bagging with you, then you have the option of doing it straight off. Not your fault, just something maybe your preceptor will do next time they have a newbie. In years to come it will happen to someone new and they will feel the same as you do now. You can be there to bag the baby and say 'dont worry, happens to us all' x

I'm training to be an ANNP in the UK at the moment. I've always wanted to do it since my nurse training, one of my supervisors was an ANP and I loved the role. So 11 yrs on as a NICU and transport nurse, I finally am doing to course! Am enjoying the new role, it's very different though. I feel that I don't 'know' the babies and families so much, we see our room of 6 ICU patients and then do anything they need, so procedures, ordering bloods, speaking to other specialities etc, also helping out in the other rooms if they are busy or the docs are junior. on top of that we have the delivery bleep, so back and forth for instrumental deliveries, sections and reviewing infants with low sugars, rashes, temp etcetc on the poastnatal ward. I'm really enjoying it, it's a steep learning curve and being back at uni is weird but it's what I've always wanted to do :) Good luck!

50mins! Oh my days that's ridiculous for any baby, never mind such a prem. Sad that mum couldn't have that time holding her baby.

Hi all, I know this is an often discussed topic but I'm writing an ethical paper on the differing care between babies of Jehovah's Witness and non JW families. My thought is this... should we be giving ALL babies the same standards? Locally we prescribe EPO and ensure v minimal bloods of all JW babies but not so much the non JW babies. I mean we are careful how much we sample of course, but it's not so strictly managed. We accept lower Hbs before transfusion too. I wondered what you all did in your area. Thanks so much, Debs

Bortaz thats what we used to use but now we have fp proper ones with velcro in different sizes. Nicugal why didnt you like them?

Yeah my thoughts exactly. It just works, really can't understand why we would stop using them. I think we will end up using a much higher flow to maintain pressures.

Hi we have always used chinstraps to close babies mouths when on cpap. This keeps the flow lower because its not lost out of their mouth when it gapes open. There is now some discussion they are not needed and I wondered if any of you lovely people had experience with or without them. Thanks