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  1. littleneoRN

    Awake, alert, oriented & non ventilated...on ECMO??

    I've seen a picture of someone ambulating on ECMO. Our center isn't that brave. Yet. :)
  2. littleneoRN

    NICU Nursing

    Consider checking out the NICU forum on there. Go to Specialty on the top. Choose Critical Care Nursing. Then there is a link to NICU. There are plenty of threads on this very topic if you search back a bit. Plus lots of other great info if you are interested!
  3. littleneoRN

    picc lines and TPN

    The whole point of the three lumens is to be able to run things that are non-compatible. It seems like a waste to add a PIV when you have three lumens that empty separately into the vein. In the NICU, we use TPN as our maintenance fluids and often have limited access for pressors/meds/etc. We ROUTINELY run drips and give meds with our TPN, assuming they have tested compatible. There are some incompatible that require a separate lumen or line, such as Ampicillin or Versed, but this doesn't mean there should a blanket rule. We try to interrupt the line as infrequently as possible to reduce infections, so we use a closed med line system and a 30 second scrub of the hub. Our CLASBI rate is quite low. I know this is a different population, but the IV compatibility issues are the same.
  4. littleneoRN

    Do you use oxyhoods?

    The hoodbox for the pneumothorax is 100% FiO2 for a nitrogen washout. The administration of 100% oxygen to term infants ("nitrogen washout") is said to potentially resolve the pneumothorax more rapidly. The theory is that nitrogen in the air contained in the pleural space passively diffuses across lung into alveoli full of 100% oxygen. This encourages resolution of the intrapleural air leak. We use hoodboxes for preemie RDS kiddos who do not need CPAP or intubation. One of the reasons is that you can accurately measure the FiO2 needed. The FiO2 delivered by cannula is estimated at best and varies with the liter flow and accuracy of the blender. I have never ever used a non-rebreather mask on a newborn. Just nasal cannula, hoodbox, or something more invasive.
  5. littleneoRN

    Response to Pregnant Friends

    Thanks for the responses thus far. I agree...I generally keep my mouth shut if no one asks, but fortunately/unfortunately, most people ask. Like I said, although I disagree, I'm supportive and know that most kids are born healthy. The problem for me is that it's no longer just a small statistic if it happens to you. In my state, too, it's underground, so that constitutes a large part of my nervousness because some midwives are great and some not so much. I have taken care of too many kids born at home or in birthing centers when things went terribly wrong. Some of those things could have happened in the hospital, but they might have not become as serious. Others were specifically related to the homebirth scenario. So, once again, I respect people's decisions and don't go looking for a fight with my friends. I just love and care about them, so if they ask, I want to be honest. But not too honest.
  6. littleneoRN

    Response to Pregnant Friends

    Hi all! I have been an NICU nurse in a large referral center for 4+ years. I do not yet have any children of my own, so I have no personal birthing experience and know that my opinions are limited by this. Obviously, though, given the nature of our job, I have developed some opinions about childbirth. I would say that I generally lean towards supporting/encouraging more natural birthing methods, but DEFINITELY in the hospital setting with the appropriate equipment and personnel available for emergencies. In fact, because of things I have seen, I'd be hard pressed to not deliver in a large hospital with a good NICU. I'm not criticizing small hospitals. I just have seen too many births end in unexpected nightmares, and I want all hands on deck so I don't have to be the anxious NICU nurse freak in labor. :) I have lots and lots of friends in the childbearing stages of life, and more than a few of them veer toward the end of refusing interventions that are probably helpful/necessary and/or homebirths. I am NOT looking for a debate on birth interventions or home births. I know what the research says, and we don't need to rehash it. I know that there are many NICU nurses out there with similar viewpoints about the reality of birthing, both good and bad. If you have friends/acquaintances who are choosing home births, do you share any of your feelings? If they ask your opinions, what do you say? Honestly, I know that my friends who make those decisions don't make them lightly. They have done their research and feel they are making the best decision for their family. I want to respect them and their decisions, but I worry about the 1 in 10000 type of things. Plus, I find that if I tell them I'm worried about the "What ifs?," then they ask me more about them. And then there's that fine line of telling people what I mean without pouring out a horrible list of things that can happen to babies and moms. Because I'm not looking to give people nightmares or anything. I don't want to force my opinions on my friends, but I love and care about them. And given my profession, my opinion gets asked a lot. So...what do you say? p.s. Just once more, please don't make this a home birth debate. If you disagree with me, I respect that. However, that is not the question I'm asking here.
  7. littleneoRN

    NICU nurse making the jump to PICU!

    And your newborn patients never grab their ETTs? :) We don't always have time for the three minute scrub either, but we make time if at all possible. Ideally, the offgoing nurse doesn't leave til you're scrubbed. HAIs cost patients a lot more than a lot of money. I have some experience with PICU, and there is definitely more variety. I don't know that I'd blanket say that it's more challenging. That depends on your unit and population. You can get kids who are sick as can be in either unit. Have fun learning lots of new things!
  8. littleneoRN

    Traveling with intubated patients

    Ok, I work in NICU too, but the only real big difference here is how hard it is to maneuver the bed. In reality though, our beds are often almost as big and heavy as yours...they just don't come with a 100-500 pound person in them. :) Sometimes we bag...other times we use a transport vent. Bagging is a full time job since we're bagging at rates of 40-60 bpm, so this person really can't be doing much steering/pushing. This is usually an RT. Depending on the patient's needs, we usually bag through the procedure but may use the transport vent or a bedside vent. Two pushers...either 2 RNs or an RN and an extra RT. Plus an extra to push the IV pole, etc. if we can find someone. And for all intubated patients, a provider who can manage the airway/reintubate if necessary. This is generally a nurse practitioner. So in total, 1 to 3 RNs, 1 to 2 RTs, and one practitioner for the actual transport. One RN, one RT, and the practitioner must stay in attendance for the entire procedure. Now think about transporting a patient on ECMO... :)
  9. littleneoRN

    Blood products question

    We don't transfuse through our PICCs because they are 1.9 fr, but we routinely transfuse via 24 g IVs. We rarely use 26 g, so I can't comment on that. It's true though that we transfuse MUCH slower. My transfusion is often running at something like 6 mL/hour. It will take you a while in peds or adults at that rate. :)
  10. littleneoRN

    Additional NICU sub-specialites?

    Nurse Educator
  11. littleneoRN

    new drug-Avastin for ROP

    How many times does a baby receive this in a normal treatment?
  12. littleneoRN


    To just add to the previous poster, who is right, antibiotics are chosen to have a broad spectrum until an organism is identified. However, depending on the timeframe (birth, post-op, etc.) and presenting symptoms (fever? questionable NEC?), there are certain more likely organisms. So with your questions about the preemie with r/o sepsis and then r/o NEC, the antibiotic choice is based on the most likely possible culprits.
  13. littleneoRN

    NaHCO3 lead to SVT?

    Disclaimer...Newborn ICU nurse here... I have been taught by our docs that hemodynamically stable SVT can be quite prolonged without causing the patient harm. We send babies with hx of SVT, medicated, but without any type of monitor or anything. The parents are taught visible symptoms of SVT and to check the HR a couple times a day, but the docs say a baby can be in SVT for 24+ hours before it will start to induce heart failure. Are these principles true for adults too? If so, I'd say your judgement not to give adenosine was good. Other maneuvers we use to induce conversion in a baby are ice pack to the forehead or passing a feeding tube to induce a vagal reaction. Also, my understanding that bicarb in a code situation is a buffer to metabolic acidosis (assuming adequate ventilation). So, my guess is that raises blood pressure and pulse by reducing tissue acidosis and promoting the heart's ability to more adequately perfuse the tissues, including it's own. Which would lead to improved HR and BP, correct? Am I understanding the very basic pharmacology correctly?
  14. littleneoRN

    When to call in sick to the SICU

    I feel like this is a valid question, and there are finer points that aren't really getting addressed. For example, if I worked as, for example, and engineer, sitting at my desk working most of the day, I would go to work with a normal cold. However, I will not go to work in a the neonatal intensive care with a cold since my patient's are vulnerable at best and more often vastly immunocompromised. This is supported by our management/infection control. We are not to come to work with a fever. If we have strep, etc., we need to be 24 hours on antibiotics before returning to work. Some people with minor symptoms will come to work with a mask, but generally if you are sneezing/coughing/etc., you stay home. This means more sick days then if I worked in a different profession, but it's only fair to our patients.
  15. littleneoRN

    Computer charting- How often do you document vital signs

    Oh my! If I had q 15 min VS to chart on two patients without monitor interface, that would pretty much be 1/2 or more of my day!