twizzlers67

Lately I've been so nervous about air bubbles! I'm not sure if it's just that I'm noticing them a lot more now than when I started out but they can be pretty scary. I am less worried with the PIV but mainly my UVC and especially my UAC. Our UAC's are only used for blood draws and bp monitoring. When I draw blood from my UAC we need to draw back the blood past the access port so you get a fresh sample free of a-line fluid. When I am finished and go to flush the line to clear it, I can see a small gap of air in the tubing past the access port that luckily is caught in the trap before it gets to the baby but I always worry that it won't trap and will go into the baby. What do you do if it makes it past the trap? pull back on the syringe and try again? Any thoughts?

any research out there to back up either of these methods?

Thank you all for your great advice! And raindreamer, yes it is a new 24 wkr. I understand what you mean with the old 24wkrs who are normally a little labile, what sort of things would you be worried about/look out for in this instance?

Thank you, I feel a lot more comfortable now not jumping on that oxygen dial right away. I will definitely go slow when I do need to turn it up as well. And I think you're right that I may need to give him a little break when he starts to desat with hands on cares and I'll see what I can do to help position him a little more comfortably.

Does anyone have any tips on how to get things to stick to your baby when they're on 70% humidity? Ex. Leads, temp probe, tegaderm. I feel like I have to change them out so many times in a shift to get them to stick!

I'm a new RN just off orientation and I've been taking care of a 24week preemie on SIMV. I've been struggling with a few things mainly his oxygen support. It can be such a struggle to balance his O2 sats with his FIO2. He will desat and I give him time to come up but how much time is too much time? At what point do I decide it's time to turn up the oxygen. I know I don't want to give him too much 02 too quickly for fear of IVH and ROP but when he continues to drop his sats I'll look at him to make sure the tube is in the right placement, make sure it's nothing mechanical, then give him a bump in his oxygen. But when do I decide okay he may need another bump of oxygen? How long do I give him to respond to the 02 change? I know he may just take a while to come up but it seems like an eternity watching him sat low and waiting for him to come up on his own. It seems like anything I do to him agitates him and will cause him to desat but I know I need to get in there to assess him. I try to get it done quickly but calmly but even doing something as simple as changing out a diaper can be difficult because it bothers him and causes him to drop his sats. I give him time to recover but at what point do you determine he's not going to bring up his sats on his own and may need some 02? Sorry if this is a confusing post, I have so many questions with I'm sure many different answers that come with experience but having little experience makes it difficult to make the best decisions for my patient! I have a lot of support from other RNs on my unit but I just wanted to see if I could get a little more from the forum. Any suggestions for caring for a 24 week preemie in general would be helpful as well! Thanks!

No we don't have any one on one meetings set up with a CNS or manager although it'd be a nice thing if we did! I do keep a cheat sheet with things to remember and I go over it on my days off from work to try and familiarize myself with the info. it does help to have it handy on the unit. I think it comes down to time management and prioritizing.. like me forgetting to fortify the breast milk at the beginning of the shift then having to get it ready in a hurry for the feed and feeding late. then after hanging an ng feed realizing I never checked a residual! Little things like this that I know will come with practice and time but it's so hard not to beat myself up over when I make one little mistake after another. And I absolutely agree it's good to take a step back and see if from the perspective of my preceptor. I can't imagine how tough the job must be (and kudos to all of you for taking on new orientees!) and I am very thankful to have her there to ask questions and help out when needed. I think the issue is that I feel like a burden on her and I get so nervous to make mistakes because I know that will only make more work for her and that's the last thing I want to do. And I know I'm new so I will make mistakes but just to see the frustration on her face makes it so difficult to bring my self-confidence back up from a tough event. I think I will try to open up the line of communication with her and let her know how I'm feeling about my own progress and maybe she will be able to help me understand a little better about where I should be. Thanks again for your response!

Thank you all for the great advice and words of encouragement. Hikernurse I think you're right when you say the information overload makes it difficult to learn new things. And Ittybittybabyrn it does make me feel a lot better to know everyone feels this way. I guess it just feels so much different when you're in the middle of it and know that you have so much more time before you feel semi-comfortable. I can't wait to get to that point and be able to give advice to other new orientees. In fact what you said, and elizabells mentioned too, about being off of orientation and just being able to stand at the bedside and think for a minute without feeling the pressure of someone watching you is nice to hear. I think that is what I am missing when I begin to get flustered and make mistakes. All I can think about is how I must appear to the people around me and I don't get a chance to allow myself to stop and think about what is happening and what I need to do. I absolutely will find a buddy to help answer my questions and keep me from losing it when I'm having a rough day. Orientation truly is a boot camp ughh I know I just need to suck it up and keep truckin through it! Thank you guys, I feel a lot better about where I am at and hopefully I can come back to your posts when I'm feeling discouraged.

Hello everyone, I apologize for this post now but I need somewhere to vent my feelings. I'm halfway through my orientation to the nicu and I feel like I might not make it to the end. The first few weeks I felt great and felt like I was catching on but now I feel like I am falling behind...and even backwards! I forget the most simple tasks and get flustered, then fall behind. My preceptor isn't very encouraging either and can be very judgemental and critical when I make mistakes..which ends up putting me under even more pressure and stress to get it right and I get so nervous with her watching me that I mess up. I used to do a great job at drawing labs but now I get so anxious and my hands start to shake and I can never seem to get it right or fast enough. My preceptor just took the ampule right out of my hands yesterday and did it herself. I can see she's getting frustrated with me and my pace and my forgetfulness but her attitude and lack of support at times (she can be supportive at other times) just makes learning more difficult. And when she corrects me on a task it comes off less as a reminder now and more of a lecture. At this point I just feel totally inept for this job and it only shows as we move on to more critical patients. I nearly had a breakdown during lunch the other day because I got so caught up in my mistakes and it seemed like the more I fell behind, the more I made! So much of this job I feel comes with judgement and experience..all of which I'm lacking so how can I ever get anything right? For example..checking residuals..something so simple yet I never know whether to chuck or refeed. I know that if its undigested you should chuck, and anything more than 50% or billious.. show the MD..but how about if its say 6 ml of partially digested milk..do i refeed this then subtract the volume from the next feed or refeed and feed over top??..its such a judgement call i feel but i never know what to do and then always end up doing the wrong things (chucking when my preceptor wanted that refed..ugh). There doesnt seem to be any standard for this. It feels like there isn't anyone I can talk to who understands..venting out on here does help some however. Any words of advice or encouragement would be much appreciated! Because I'm thinking I may not be cut out for this job

Thanks everyone for the info! Now I'll feel a lot better about taking a second to remove that tube (and save the cheeks) to get a good seal. Its reassuring to know that it can happen to anyone and I'm glad I'll know what to do! Thanks again :)

Hello all, I'm a new nurse in the nicu (still on orientation) and I was wondering what to do if my patient self-extubates. I understand that if my patient's sats are hanging in the 40s and there's no audible breath sounds/chest rise I can assume the tube's slipped out of the trachea and I should bag with O2. But should I just pull the ET tube out? and if I do pull it out won't it still be taped to the lip/face and get in the way when I am trying to get a good seal with the bag and mask? I cant imagine taking the time to gently pull the tape off of the kid's face but at the same time I know it would get in the way while trying to bag. I'm just a little confused about this and the events that follow. I'm so nervous that my vented patient will jerk his head in the wrong direction and I won't know how to react! If anyone could shine some light on how they handle an accidental extubation it'd be a huge help!