HighCensus

We have three sizes of OG/NG 5 fr, 6.5 fr, and 8 fr. We choose the size depending on the patient's weight. We use the tube for both venting and feeding. If a patient has a 5 or 6.5 fr we will often pull air off q3-4 hours. We also use 8 or 10 fr replogles for decompression.

I just got done developing guidelines for the use of bathtubs in our NICU in conjunction with infection control. Most evidence based information is going to be against the use of bath tubs. Because of our unique population in my unit we worked on guidelines that would balance infection control prevention and developmental care. With that being said not each of our patients qualifies for a bathtub. We bathe patients every Tuesday/Saturday and prn. For our smaller babies or unstable patients we use bath wipes. Patients progress to sponge baths, swaddle bathing, or tub bathing depending on their developmental needs. We use J&J for bathing although some patients have Aveeno baths scheduled. J&J lotion depending on the patient. Here are two resources for bathing: Am J Crit Care. 2009 Jan;18(1):31-8,41; discussion 39-40. doi: 10.4037/ajcc2009968 Am J Infect Control. 2012 Aug;40(6):562-4. doi: 10.1016/j.ajic.2011.07.014. Epub 2011 Dec 16

We rarely use the jet...but our orientees get experience with HFOV while on orientation. As a preceptor you request your patient assignments and that is one of the areas we train our orientees in. Orientees also spend 4hrs with one of our RT's going over all the vents we use. We are lucky that with the number of patients we have our orientees get a very well-rounded experience.

I think we are still considered a 65 bed unit...although it should be changing as we have expanded. We have 64 bed spaces (8 bed spaces in 8 pods), 5 private rooms, a ten bed "stepdown" unit, and a ten bed "micro-preemie" area. Our census has been 80+ for a while now. We are a level III with HFOV, NO, ECMO, and surgical services. We pretty much do it all. Lots of variety.

Lately we've all been having dreams of putting our kids in bunkbed bassinettes. All jokes aside our census was 80 on Sunday. We are currently working with 37-40 nurses per shift. Amid all this fun and excitement we have went to ECMO in the unit, electronic MAR's, opened a new area of the unit, and are getting ready to open another area. Before the new areas opened we were considered a 53 bed unit. HaHa! Now we are a 65 bed unit...with 80 patients. We are set for a major expansion in 2010...we can't wait!

I have been in this situation before and can sympathize. I would tactfully remind the family that this was an intensive care unit. I would then explain to the parents that little [EVIL]Damien's[/EVIL] behavior was loud and disruptive to the other patients and if he could not settle down then one of them would need to remove him from the unit out of respect for other families. Get the support of your charge nurse/coordinator behind you. Most of our parents know that we expect siblings to behave appropriately or they will not be allowed to visit. We've even had to go so far as get social work involved at times and get parents to agree to a contract for standard of behavior when in the unit. Good luck:up:

I think our unit has forgotten what low census is. We have had to make major renovations to expand our unit due to our prolonged high census. We were technically a 65 bed unit and I know last weekend we had 82 patients. The second phase of our expansion is I believe opening in Jan. Maybe that will give us some breathing room.

Does anyone have a policy for minimal stimulation/IVH protocol that they would be interested in sharing? Would love to gather some evidence-based information if possible. Thanks.

For our team there are two purposes to mobile ECMO: 1) If we receive a referring call for a patient who is too unstable for conventional transport it allows our team to go to the referring hospital, cannulate there, then transport the patient on ECMO back to our facility. 2) In addition we serve as a backup suport system to address medical needs that may exceed the resources of outreach institutions. We are able to support I believe up to six patients at a time on ECMO while many facilities close to us can only support one to two at a time. Thanks for the great question!

"Mobile ECMO" is basically the ability to transport patients while on an ECMO circuit. I don't know the latest data but as of April 2006 Arkansas Children's Hospital was one of only three institutions in the United States to offer air transport of critically ill patients on an ECMO circuit. Here is the link tofor more info on our program. http://www.pediatric-cardiology.com/Heart%20to%20Heart/April/H2H_April.asp#ecmo

Arkansas Children's Hospital uses RN's and RT's as ECMO pump techs. We are required to have ICU experience and to complete extensive training as we may be required to work in NICU, CVICU, or PICU. I am currently in the middle of training to work on a prn basis in addition to my regular hours in the NICU. Please feel free to PM if you have more questions. FYI we are one of the few hospitals that also does mobile ECMO...not that I'm bragging or anything I love my job!

We are updating our policies and procedures and are currently looking at our policy for surfactant administration. One of our NNP's mentioned that she had read somewhere that it is no longer necessary to change the baby's position (right side down, left side down, etc.) during the administration of Survanta. I have been assigned the task of researching this and so far have been unable to locate any information supporting that. Has anyone heard of this? What procedure does your unit use? Thanks.

We are busting at the seams and have been for quite a while. Our census has been 70+ and we have even seen 80+. And right now our acuity level is way up. We are staffing sometimes with upwards of 40 nurses. Just this last weekend we had two pts on ECMO and a transport call for a 3rd possible ECMO. I believe we have approval to hire 56 more nurses so please send some our way!

In the interests of family centered care we are reviewing our policy on the visitation of grandparents and siblings. We are interested in how other units approach this. Question #1: Are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100). Question #2: Do you limit the amount of time of these visits? Question #3: Do you allow grandparents to remain at the bedside during physician rounds? Question #4: Does your unit have individual rooms or an open concept (multiple bed spaces within an area)? I know visitation has been a previous topic but, I need to relate the information to units similar to mine. Thanks.