PrudenceNurse

I write fiction. I could compose a lovely story about the magnificent women who inspired me to become a nurse. I could tell you in poetic prose about their near-saintly lives, deep caring for their patients, and a profound love of humankind. It would...

In our unit, the Respiratory Therapists have NOTHING to do with the pulse oximetry. We are responsible for rotating sites and for adjusting FIO2, etc.

How about the "Eakin ring"? It is a moldable pectin-based substance. You can roll it (like playdough) into a "snake" and then mold it around and between the stomas to form a flatter surface that bags will stick to better. I've also tried using a "No-...

Our Level 3/4 NICU does hire new grads, and we would probably be more likely to hire someone who had done an internship (or preceptorship as you called it) in our unit over someone who had not.

We don't have a written policy (perhaps we should), but we teach that aspiration is the best way to verify placement. Auscultation is not very accurate, especially in the micro-preemies, because if the tip of the tube is in the esophagus, you can sti...

What exactly is a "bio-occlusive dressing"? Tegaderm? Please give more details/examples?

We have Extremely Low Birthweight Guidelines that include: no leads; "soft touch" pulse ox probe with no adhesive; mist tent for 72 hours; after initial bath, water only (no cleanser) for two weeks; remove all Betadine/Chloraprep with sterile water A...

I started in a NICU as a new grad 27.5 years ago, and have no regrets. I would NEVER want to do any other kind of nursing. I have never had a problem finding a job in any part of the country. I got an MSN in Nursing Education in 2007 and have done ...

We zero all fluids on pumps at midnight each night.

We change all lines/tubing only twice a week on Saturdays and Wednesdays as a part of a CABSI initiative. New syringes/bags of course must be put up every day. For the extremely fragile baby on pressors, you can make a whole new set of fluids and med...

One of our NNPs developed a great feeding protocol that the nurses "order" everyday after calculating volume based on mLs/kg/day. We have the same stops and starts with the micropreemie, but it has made it very easy because it is nurse-generated. Re...

We have the same problem with RTs in my unit. I do what you do--put on Duoderm and switch from prongs to mask frequently myself. The other compliance problem we have with the RTs is their refusal to put ExtraThin Duoderm on baby's cheeks under their ...

We actually DO use Duoderm, but we use the ExtraThin Duoderm that is "breathable". If you cut it into an inverted T shape you can put the horizontal part of the T over the philtrum and run the vertical part of the T over the septum, securing it at th...

What antiseptic is everyone using for insertion of urinary catheters? Betadine? Chloraprep? CHG handsoap? For daily care, just baby soap and water like a bath, or more antiseptic? Also, is anyone using an actual Foley catheter and blowing up the ...

We are doing a quality improvement program in our NICU to decrease our Catheter Associated Blood Stream Infection rate. I would love any information from other units about how you do line changes and how often, closed medication systems, sterile vers...

We are trying to get away from using any tape directly on our babies' skin because of the damage it causes, especially in micro-preemies. They make a "gel" strip to use instead of tape, or we put Extra Thin Duoderm (a breathable hydrocolloid) on the ...

The AWHONN recommendation is for NO antiseptic treatment at all; it actually shortens cord drop off time and does not increase rate of infection/omphalitis in developed countries. The evidence has been there since 2001, but because of our attending's...

Ours is attending-dependent. A few of ours say that it is a normal finding in a premie and should not be treated; others try indocin/neoprofen a couple of courses, then ligate. It's frustrating to say the least. I have also heard one of the docs say ...

At 1250 grams, our kids in isolettes are changed from "skin temp control" to air temp control and are dressed and wrapped like they were in open cribs. Air temp control initial setting is whatever the temp in the isolette was when they were on skin c...

My instructor in nursing school told me I had "psychomotor deficiency", so I know how you feel. The only answer is to keep practicing and also to observe other people who do it well often. But all of us have good days and bad ones when it comes to s...

AmPicillin===I have been working NICU for 26 years in several different states, and I have never heard of a reason NOT to give meds through the UAC instead of sticking a baby for a PIV. Especially the Extremely Low Birthweight (ELB)babies. Our ELB p...

I've been a NICU nurse for all of my 26 years. Yes, it would be "limiting" if I ever wanted to do something else. Which I don't. I do have my MSN, and have started doing some teaching and clinicals in a nursing school. It was a bit of a stretch to do...

Hold-a-Line umbi catheter holders made out of the Duoderm stuff are the safest and the most gentle on the skin. The "bridge" or "goal posts" made out of the pink tape were what we used in 1983 when the smallest babies we had were 1000 grams. These h...

I don't think Tegaderm or pink tape or really any tape should be put on any micro-premie skin. We have something called a "Hold-a-line" which is made out of the Duoderm stuff that does not tear the skin when removed. The UVCs/UAC's are sutured in, an...

No "evidence base", but we have just started leaving PICCs and Broviacs uncovered and not breaking the lines to put arms in sleeves. This is being done to try to decrease central line infections from too many accesses. Some of the babies have gotten ...