300g

...and, typhoid is caused by bacteria, not a virus. Despite both of those points,... a completely uneducated response by lamazeteacher. It infuriates me when people, especially medical professionals, compare influenza to any other vaccine. They're simply not the same. Our current medical approach will never eradicate the flu. Current medicine isn't preventing the spread from animal species (pig, bird) to humans or the combination of genes from human strains with animal strains... The influenza virus evolves rapidly and replaces a previous strain. Each season's flu vaccine is formulated from a previous influenza strain. A current vaccination may or may not produce immunity to a current strain. This is why people who always get the vaccine get sick one year when they didn't in previous years. There is a very interesting (and scary) book about the flu, "Flu - The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It" by Gina Kolata. It includes information on the evolution of H1N1 ("swine flu") and H5N1 ("avian flu"). IMO, a must read. Do not tell me what to put in my body. If I got sick with H1N1, I'd stay home, just like with any other strain of influenza. Don't wear a mask, stay home! You're full of crap if you think you can productively work an 8 or 12 hour shift without removing your mask. As professionals, we should not be proliferating the media propaganda. Oh, this topic makes me angry.

It's really going to depend on your unit policy and culture. Yes, you can give ampicilllin, gentamicin and a lot of other medications through UACs (and some should never be given via UAC like inotropes). However, I'm with you and the others here... I would have started another PIV. I prefer to avoid giving anything via UAC unless an extreme case or emergency.

Wow, I see this is more of a problem than I thought. We've been using an isolette on a stretcher-type set up for our EC135 but it recently broke and we need to find a replacement. Apparently, the Airborne unit is the only one available to fit the EC135...??? I've also heard it's not getting good reviews. Any comments on that? FlyingScot have you found a solution or any more information? Please contact (PM) me!!! I'll follow up on flightmed.com as well. Thanks in advance!

It's worth the $6 to purchase it, or take the S.T.A.B.L.E. course. I don't think it would be right for me to post a copy of their chart. You're going to be able to determine your acid/base balance with a CBG. pH and CO2 should be pretty close. Where ABGs are better than CBGs is when you need a more accurate PaO2... for example, a very sick PPHN you will probably want your Pa02 greater than 100 and you won't get an accurate reading with a CBG. Two other quick notes about blood gases... some blood gas machines will calculate your HCO3 based on your CO2, so they will not report an accurate reflection of HCO3. You will see this when your HCO3 value dramatically changes between gases. HCO3 (renal response) is not that rapid. Also, to get an accurate lactate, you will need an ABG, not CBG. Hope that helps!

This chart is helpful - S.T.A.B.L.E. Blood Gas Interpretation Chart Blood gases just take practice. Is there something specific that you're having trouble with? Here's something that might be helpful: Arterial Blood Gas Interpretation

Where in Florida are you? I don't know of a specific refresher course for your situation. But I would imagine that a NCLEX book with testing software would pretty much summarize nursing school. Then, study/review your weaknesses. Something like this: http://www.amazon.com/NCLEX-Review-4000-Software-Individual/dp/0781777909 Or maybe get with a group that's studying for the NCLEX? Hope that helps. Good luck!

Don't let Magnet status deter you from applying to any hospital you'd want to work for... in fact, I'd rather apply to a hospital with Magnet status. Magnet status is afforded to hospitals who support and promote their nurses. As an ADN they might even provide more assistance for your advancement than non-Magnet hospitals.

I also enjoy attending the delivery to care for the neonate. As transport nurses, we attend all high risk deliveries. My first job as a RN was pretty much L&D. I was hired NICU but we transferred almost all the babies to our sister hospital. The hospital that hired me really needed a L&D nurse so they conned me with the idea of NICU. I ended up "cross-training" in L&D. I hated it! It would stress me out soooo much to see the babies in distress in utero. I wanted that baby IN MY HANDS! It reminds me of the feeling you get when you see a Category 5 hurricane on radar 3 days before it "may" hit your city... then 2 days, then 12 hours... (if you know what I mean.) I still get very antsy with decels at delivery... maybe it's just cord compression... maybe it's something worse... AAAARGH! I'm 100% NICU nurse... couldn't do L&D. In fact, I really don't know any nurses who enjoy both (I don't consider attending the delivery as L&D... it's the "L" part I can't do.) Most really prefer one or the other and they are just as different as Cardiology vs. Oncology. As for your senior practicum decision, I would recommend that you choose the specialty that you'll most likely pursue employment in. It may lead to a future position in the unit. I ended up doing part of my practicum in ICU and the other in L&D because NICU was not a choice. In nursing school, our local hospitals did not allow students in NICU. Best of luck in your decision!

For apnea of prematurity, as already noted, 20mg/ml (60mg/3ml) is the appropriate concentration. Loading dose 20-40mg/kg and maintenance dose 5-8mg/kg/day q24hours after loading dose. No dilution necessary. example: 1kg patient = 20mg loading dose ordered = 1ml ... maintenance dose ordered for 24 hours later 5mg/kg/dose = 0.25ml IV q 24hours. And general practice doesn't monitor caffeine levels anymore.

I think it's great that you would like to work NICU after your experience. You will have a special advantage in relating to the parents of your patients. As NICU nurses, we understand the HBP, anxiety, and depression meds and stress that you go through with your child in our hands. I wouldn't worry about that aspect of it. However, I highly recommend that you don't work as a RN in the same unit that your daughter was in. To be quite honest, you may learn things about the unit that you really don't want to/shouldn't know. That's just MHO but I wish you the best of luck in your endeavors!

I'm sorry to say you will be disappointed by the pay here in Tampa. I moved here from Texas and took a $22K/year pay cut to work at one of the largest hospital in Florida. ouch. All of my experience is NICU LIII. I fear what non-acute/specialized RNs make. $32/hr is probably reachable, but I'm not there yet. Good luck!

We use HMF, usually 1 pack/25ml so no measuring equipment involved. We have a separate room, but it's very small so sometimes the BM/HMF is mixed at the bedside. I believe our standard initial TPN/HAL is also 3g/kg protein... I'll have to double check that. Our formula fed premies also start exclusively on 24cal. We don't generally fortify BM initially, but when they aren't growing well, like you mentioned. We also use Beneprotein (1/8 tsp/30ml). Those are the doses I've seen used in our unit. There may be others but I don't work with those patients that advanced in their feeding very frequently. Hope that helps!

if this was a written order, it reads to add 2 units heparin to 10ml 1/2ns vial (or use a prefilled 2 units heparin per 10ml 1/2ns --- 0.2 units heparin/ml 1/2ns)... then withdraw 0.3-0.5ml to use to flush. i can't imagine that this is your units policy. that's how babies get 300-3,000 units of heparin by "accident". if you used the lowest concentration heparin vial available (10 units/ml) you'd be giving 3 units of heparin and that's the highest concentration i've ever heard of in neonates. in all honesty, your question sounds like you might not completely understand the purpose of flushing lines with heparin or the volumes required for each type of line in your facility (they vary). you should really bring this question to your preceptor or more experienced nurse so they can explain to you. also, review your units policy/procedure and if this is an isolated/exceptional order, clarify with the person who wrote it. i don't like answering this type of question online as you may not have supplied all the information necessary for a complete and accurate answer. this can be a very dangerous situation for your patients! please ask your coworkers this question!

In addition to plastic wrap, humidified isolette, etc., we use Transwarmer mattresses under the patient.

There's a hospital in Tampa, FL and and in St. Petersburg. Both are Level III with ECMO except the one in St. Pete does their ECMO in CVICU not NICU. Both are fairly large NICUs and both are in the process of large expansions. One hospital is situated on Davis Island, an affluent area of Tampa and there are other, nice and more affordable areas nearby (inner Davis Island, Hyde Park, South Tampa). If you don't mind a 30-45 minute commute, North Tampa and Brandon are a little more family/children sub-division type areas. The other hospital is in South St. Petersburg... probably not an area you'd want to live in. However, within that 30-45 minute commute, there are some nice places in North St. Petersburg. Good luck in your search! You'll have to PM me for names of the hospitals because according to a new policy, employees are not allowed to post anything representative of the hospital on public forums. Sorry.

That would have been the perfect response. Wish I'd have thought of it! The baby lived for 3 days.

Hopefully this will change soon. Two of us transport nurses and an ARNP from our unit (TGH) attended the conference.

Everything that chare said! It would take quite a while to post all the alarms and their meanings for each of the settings on all the ventilator types. For example, on a Drager Babylog, a very common alarm in AC/VG mode is MV Low... and that usually means you have a large leak. You need to know which numbers on the display correlate with the alarms you're hearing. Interactive learning with your RT would be best. If there's a specific alarm you'd like to know more about, post the alarm message (if you have one), type of ventilator, ventilator settings and what the baby was doing at the time of the alarm. (See how complicated your question really is??? ) Best piece of advice I can give... until you learn all the alarms and functions of the ventilator... learn how to properly use an ambu bag. It is your best friend and if anything goes wrong, you'll have peace of mind in knowing that all you really need to save that baby's life is the ambu bag.

I'm curious about this too. There were only two countries mentioned that were initiating probiotic use. I think China and maybe Norway...? UC Davis is/will be conducting a study on the use of pre/probiotics. Here's a good article on that if you're interested: http://www.nichd.nih.gov/cochrane/GHenderson/HENDERSON.HTM

Here's a simplistic drawing I found of a bridge: http://www.cs.nsw.gov.au/rpa/neonatal/html/images/Image10b.gif My current hospital uses thin duoderm to abdomen and looped lines secured to duoderm with tegaderm (like a lot of others have described). My favorite hospital used a "belly band" and secured the lines to that with tape. We'd tie umbilical tape in a loose circle around the babies waist, then secure the lines to the band with a piece of cloth tape labeled with a V or A. Very secure with no tape/adhesive on the skin at all, and easy to remove lines individually.

2 years and 2000 hours in the specialty is required. I don't know if they differentiate between LII/LIII. My background is very large/very busy/very sick LIIIs. In addition to what Steve posted, there are a lot of questions on E/VLBW and FEN management in these patients... and don't forget your dopamine drip calculation! There are also quite a few cardio-pulmonary questions. Know PPHN, pulmonary atresia, TAPVR, TGA, right-to-left/left-to-right shunting, coarc, PGE1 and all the other cardiac meds. You also need to be pretty familiar with iNO, HFOV and somewhat with ECMO. There were a few questions "Your ABG looks like this... what vent changes would you make?" Know your lab values and how to calculate ANC and I/T ratio. Know s/sx of hypo/hyper kalemia, natremia, calcemia, glycemia, magnesemia and their treatments. Know autosomal recessive/dominant, know transient neonatal pustular melanosis, harlequin sign, Strawberry hemangioma and "Blueberry Muffin rash"... I bought the Core Curriculum book and borrowed the review questions (with rationale) book. I think I opened the Core book 3 times but completed the review questions book. I think it helped me focus my study and identify my strengths and weaknesses, but as Steve said, I really had to draw from experience. The test is not a "regurgitate information" test... you really have to know the entire patient picture. Almost all of the questions have 1 wrong answer and 2 correct answers with 1 of them being "more" correct. I think if you read, understand and can apply most of the Core Curriculum book, you'd do just fine... but that's a lot of in-depth info. Honestly, I can't recommend any study alternative to experience. With the blurred definitions of LII/LIII and even LIV, it's hard to say that an experienced LII would not pass the test. However, I can't imagine that someone prepared for the Low Risk Neonatal test would come close to passing the Neonatal Intensive Care test. (my opinion solely based on the names of the tests) Hope that helps!

Current studies support this method of initiating feeds with micro premies. Early on, increasing to full feeds quickly as tolerated and with breastmilk or BM with human (not bovine) HMF and no formula. I'm at a NICU conference and when I return and digest all this new, great info, I can post more on the latest data and findings if anyone is interested. You can resume feeds within hours after giving Indocin.

I'm guessing your baby was 1100g. :wink2: (NS dose of 10cc/kg) Not really. Supine with head midline is good, so is Left or Right, or partially Left or Right... just so long as the head is midline. When you turn the patients head, it can obstruct blood flow to/from the brain. That's all I was trying to say. There really isn't any reason that umbilical lines would prevent positioning to the Left or Right... except for maybe an individual hospital's policy (that may need to be updated ) And just to add my again... the baby may have been hypovolemic causing low BPs, but I disagree with the others that hypovolemia has anything to do with the finger/abdominal discoloration. I'm sticking with vasospasm due to the rapid recovery after proper intervention.

First of all,... don't be so hard on yourself. Sounds like you're doing a great job! Just to clarify... I didn't mean to mention midline positioning in reference to the vasospasm. Midline positioning, although relevant to blood flow, has more to do with carotid supply to the brain and jugular drainage in prevention of IVH. Turning the neck like you explained restricts blood flow to/from the brain, so you should keep their entire body midline... also has a to do with developmental positioning, but that is another topic. In reference to xray confirmation of line placement... they may not have been in correct position when initially placed. Your assessment was probably fantastic... but if they're not in the correct position from the start then your fantastic assessment wouldn't really matter. :wink2: Can you recall your patients weight and the cm mark of the lines? Your UAC should be 3 times the pt weight in kg plus 9 and your UVC should be 1/2 the UAC plus 1. example: 1kg x 3 = 3 + 9 = 12 for UAC and 1/2 x 12 = 6 + 1 = 7 for UVC Then confirm placement via xray... UAC line tip should be between T6-T9 and UVC line tip should be just above the level of the diaphragm. Also sounds like your BP was low. Mean BP should have been around 25 mmHg. At 2mcg/kg/min, you had a lot of room to move up on your dopamine. Your NNP may have needed to watch that patient closer. Your waveform can still be peaked, especially if you've set your monitor at 'optimum'. Dampened waveform is more a symptom of a poorly functioning line than patient's BP. If your BPs are low via arterial line readings, you can usually confirm pretty accurately with a peripheral (like you did) and measure the right upper arm, if possible. I'm sure you drew your labs just fine. The only thing I would add is that it should take no less than 40 seconds to withdraw or replace your blood from the line. This helps prevent rapid changes in blood pressure and subsequent perfusion. Hope that helps!

We also provide an admission packet with a general "Welcome to NICU" booklet that discusses basic terminology, what you can expect, care team member descriptions, etc. Additionally, we have a storage room full of information sheets that we add to the packet (whatever pertains to the patient now or in the future)... PDA, jaundice, caffeine and AOP, IVH, sepsis, etc. and we can print medication information sheets from the online pharmacy. As already noted... discharge starts at admission.