I'mANurse!

I don't work with insulin much, but I do remember that there is only one type of insulin that can be given the IV route! Hope that helps :)

Amp and gent are used while awaiting blood culture results because they are broad spectrum antibiotics, meaning they cover many different types of bacteria. Once a culture comes back positive, the medication will be adjusted based upon the organism identified (gram pos, neg, staph, etc) and will be specific enough to treat what the baby actually has. Hope that helps!

For those of you that have taken the neonatal RNC or CCRN exam, how well were you doing on practice questions? I'm about half way through the core curriculum question book and have an overall average of 82%. Is this good enough to pass the test? I remember getting worse scores studying for my nclex and I passed, but I'm not sure how that compares to this test! I'm hoping to take the test within the next 2 months, but I'm getting very nervous!

We use NGT most of the time. Many times OGT are initially placed during resus to vent the stomach if any PPV is given and Babies on CPAP have OGT to continuously vent the stomach. Once feeds are begun or the baby is off CPAP, we usually transition over to an NGT. Part of this has to do with the actual tubes we use. Our NGT are 5 Fr, and our OGT are 8Fr. Also, our OGT are very short and are not compatible with our tubing for our syringe pumps, so hanging feeds is more of a hassle. I also prefer NGT for routine feeds because it's one less thing the baby has to have in the mouth to interfere with nippling or breastfeeding. Also, I've found that babies are able to more easily cough up their tube when its OG!

As a general rule, my unit goes by anything D13 or less can be given via peripheral. However, not too long ago during my safety checks at the beginning of my shift, I noticed that my baby had TPN hanging via a peripheral line that was D12, but had so many other additives that the osmolarity was high enough that pharmacy had written "Give via Central Line Only", but this had been overlooked by the nurse hanging the fluids since we allow up to D13 to be hung. Yikes.

Kudos to you summerlove2. I know how hard it can be try and bring about change in a unit that is so resistant to change, and especially when you are the newbie! Believe me, I've been there! But it's obvious that you care so much about your patients and want to bring about important change. Keep up the good work, and don't let others who do things "because that's the way they've always been done" discourage you. Nursing is constantly changing, and part of being a good nurse is keeping up with the evidence and best practice standards. Good luck with your new job!

That whole retrograding sounds very dangerous, especially on such fragile patients! What if the nurse accidentally forgets to clamp the port.....the med will end up being pushed in! And having to recalculate your fluid rate while the med goes in? Sounds like to many places for errors to occur and not very safe! I wonder if it is even considered an acceptable standard of care in the neonatal world anymore? Syringe pumps are so much easier, why wouldn't a unit use them?? Very interesting! And your unit should definitely be using a neonatal type drug reference, as we all know things are very very different for our babies!

Do you know the gestation of this baby? Many times micropreemies are under therapy, but are too unstable to be moved constantly, especially if they were just born, as their risk for developing intraventricular hemorrhage at this time is extremely high. In these cases, minimal handling is best. The eyes should always be covered though. If it is a larger baby, and/or one that is being fed, they are turned more frequently and get breaks from phototherapy during their feeds or brief holding by parents.

I agree with SteveNNP, only fill the tube halfway between the first and second lines. My CBCs used to always clot when I first started working in the NICU, until a coworker shared this tip with me. They rarely clot now, unless the kid has really sludgy blood!

I've had the same problem with my hands cracking/bleeding/itching by the end of my work stretch from all of the hand washing. I used to put on Eucerine cream before bed (which I still do), but I just got this new lotion called "Gloves in a Bottle" and my hands did not crack this stretch. It's amazing! It creates a protective layer that lasts for 4 hours, so I just apply it before work and again after 4 hrs. I can't recommend it enough! It's a little spendy, but totally worth it and goes a long way. You can find which stores sell it on their website, or you can also order it off Amazon.com

We use the purple ones from Children's Medical Ventures. I have a really difficult time keeping them on some of the kiddos feet, or the sticky strap falls off, so I tend to wrap one around the foot then wrap the entire foot in a diaper to keep it on.

Caroladybelle gave an excellent answer to your question, but I just wanted to point out that in your original post you were thinking that it may be because of a "less chance of systemic infection". Central lines actually have a GREATER chance for systemic infection than a PIV because your catheter is located centrally within the body and bacteria can migrate up the catheter and then be released into the bloodstream near the heart. Just something to remember :)

Before you spend money for a journal subscription, check out the online resources from your school's library. Through my school's library website, I had direct access to tons of nursing/medical journals with full text!

I work nights, 3 on, 1 night off, 3 on, 7 off. The night before my first night on, I will go to bed at my normal time, get a good nights sleep, and try to sleep in as long as I can. Which for me is only until about 9am. Then I lounge around for a few hours, and lay back down for a nap from 1-4 pm. When I have my one night off in between, I will stay up until about 3-4 am, then get a good 12 hours of sleep and wake up ready for work the next day at 4 pm. That's what I have found works best for me! Then on my last day, I am able to come home and sleep for 4-5 hours, then go back to bed that night and I'm back on a day schedule for my week off!!

Congratulations on getting a preceptorship in the NICU. You'll love it! Check with your preceptor or instructor before using your stethoscope. The NICU I work in has a designated stethoscope at each baby's bedside and nurses and docs are not allowed to use thier own stethoscope. For infection control reasons!!