lvnurs9

What do you see on your unit regarding when to intubate? It seems that there is a huge push to never intubate. I understand the risks involved, but when you are dealing with tiny micropreemies, it kinda seems almost inevitable. We are extubating kids earlier and earlier... a lot do really well... and a lot don't. Where I worked previously, we rarely saw a NCPAP of 7. If we did it was a last resort and was very short term. At my new job, we routinely use 7 and now even 8 and 9!! We just intubated this kiddo (3wk old 24weeker) who was on a CPAP of 8 for 10 days. He is so shut down and exhausted, he is still having bad events on the ventilator. So, I would like to know what are all of you doing in your units? Do you leave kids intubated forever? Not long enough? Ever? How high do you go on NCPAP? Do you notice any long term benefits or have bad outcomes? I feel like we are doing a greater dis-service to these kids by allowing them to struggle, forcing their lungs open with massive amounts of pressure, and causing more ROP and brain damage from high O2 swings and apnea/brady/desat events.

The best one yet... Athziy... this is supposed to be Ashley lol

We have a million different recipies for breastmilk... for babies under a certain weight, we fortify with HMF up to 24 cal. If we need more calories, we add neosure powder, beneprotein, and/or MCT oil. There are so many different combos, I can't keep them straight Most kids that are on 24 cal have added beneprotein and for 26 cal beneprotein and MCT oil.

Interesting point to make... we had a baby deliver recently whose mom was positive. No isolation precautions were ordered on this baby. Now 2 weeks old, her swab was positive... still no isolation orders...

My biggest frustration is having a very symptomatic kid who they "sit" on because "studies show" that treatment is not effective. How does this make any sense?!?! And I'm talking 24 weeker who has always been on vapotherm (wow) being reintubated at 3wks on a rate of 50, never able to feed.... her brother on 1/2 feeds with bloody residuals... or the six month old who can't go home cause she is in CHF.... so many babies staying way too long because they are dependent on 5L NC and O2, can't nipple... the list goes on! I mean treat them and be done with it!

So you just fluid restrict? I guess I am trying to find out how to treat them. I am not used to using meds, because Indocin is usually more harmful then good and Neoprofen never works. But, I can't figure out what they are doing wrong here that so many kids are being mismanaged and are ending up in CHF! That is one thing they can't seem to figure out here. You can't try to "treat" a PDA and run fluids at 150/kg!

Have you heard of these new studies that are apparently showing that there are no advantages in the long run to treating a PDA?? I am so used to ligating kids that are either micros or very symptomatic. At my new hospital (well 2 in this state), they are talking about not treating them anymore! I have seen more CHF in the past 8 months then in the past 4 years. How can these studies be accurate?? Are you changing your practice? Do you have any links to or information on these studies? Thanks!

Ya it just sucks all around. Looks like I could be wrong... surgery went better then expected... I pray for her and her family. They already lost her twin to NEC.

So this kid I mentioned in the other post... she was a 29 week twin... full feeds and 10 days old on NP. Had a little poochy belly all night, small residuals... nothing super worrisome. Bam. 6 hours later... no viable bowel. Took her off. That was last saturday. Last night I had her twin. Was told she looked odd and had 7 severe brady/desats that shift. First assessment had a huge loopy belly, not so soft, 7ml residual, and a huge normal stool. Of course MD didn't care and thought I was being paranoid. Next cares, looked a ton better, but was still sickly looking... pale and mottled, and just not right. She was still having spells. Small residual...fed again. By 2 I let the MD know she had 5 spells already. He didn't really seem to care and attributed it to prematurity and apnea. He wouldn't look at her... So no significant change by morning except a total of 7 spells. I asked if I could increase her NP from 0.5L to 1L to see if it helped... then I went home. She slowly got worse on days. They even did an x-ray which was not conclusive and kept feeding. Finally made her NPO around 12 because of persistent apnea. X-ray showed tons of pneumatosis. When I got back they were intubating. Her sugar was over 400 and she had portal air. They sent her to Children's. Who wants to bet she dies? Ugh. This sucks. I should have been more persistent, even though I am 99.9% sure I wouldn't have gotten my way. I'm depressed....

I actually just finished writing my resume about 10 minutes ago :) I looked online for "staff nurse resume" and took some pointers from what I saw. I spelled everything out... osciallator, inhaled nitric oxide... Good Luck!

We just lost a twin this weekend to NEC. I heard Sat moring when I was walking out the door she had pneumatosis on her am xray. I am guessing that either it was a scheduled morning xray or she was fine all night until her last feeding and an xray was ordered. They transferred her that day to Children's (don't do surgery here), and everything was dead by the afternoon. She was only 800g... TTTS 28 weeks about 10 days old. Sucks, although I haven't seen any NEC deaths and only 2 other cases since being here for 6 months.

The baby is 39 weeks now, and was just sent to Children's to be ligated. The twin went home 2 days ago.

I sent you a PM Oh, and I am with Cross Country

You definately have to pay taxes on all income earned. You can't take your pay tax free, even if you wanted. I doubt your employer would let you. But, if you take the housing stipend, you can take it tax free as long as you "qualify." I agree with hiring a CPA who specialilzes in travel nursing, as there are many things most regular CPAs don't know!!

See, this kid didn't have a dx PDA until she was a month old. So... they didn't treat with drugs. They just fluid restricted her and prayed it would close. We are working on a month now, with no improvement. They won't even try diuretics in attempt to get her flow requirements down. The poor kid is dying to nipple and she can't! Her sis is going home next week.