kangarooyou

Gel e donuts www.respironics.com

We use gravity unless it is a kid with reflux, we use the pump. Not finishing bottle...the orders we ask for would change. If baby is tired, and not showing feeding ques every feed...then our dr's write nipple every other, or nipple every third etc so the baby has some time to rest and grow a little bit. If every single feeding is being nippled then gavage the rest...it may be too much for the baby, especially if the weight is not up. :)

clearing old post

Hi everyone.... I am posting to share something with you all, in hopes that you could learn from my growth and in my hope, that I can learn from you as well. I have taken classes recently, about palliative care practice, read the books, the articles. Watched fellow "senior RN's" all in the hopes of finding a way to grasp the method of withdrawl of support. I have learned, I guess....the "hard way". As I have grown in this practice, I am becoming known as the "palliative care" nurse by default. Last year, I had my first loss. A 35 weeker corrected, had been in the NI for about 3 weeks. The shift before mine had put her on low wall suction due to gastric residuals and the beginning of what we all know and hate...NEC. Long, painful story later....she passed away after a good 45 minutes of great efforts to save her...with the parents in the room...on the floor screaming and crying. That day. I wanted to quit the NICU. I ended up in a palliative care class about 6 months later, crying the whole time, and found that I may be suffering from some sort of post traumatic stress. It became blatently clear, even more so that I had a problem a week or so after the class. Running the high risk clinic that week, in came "Diana's" mother. "Dear God, maybe she doesnt recognize me" I thought, selfishly. She looked in my eyes, half way between the developmental assessment of her older child, and said "Christine, I know you tried to save her." I started balling, I had to stop and get another nurse because I was just so distraught. 35 weekers are not supposed to die....especially under my hands. Feeling completely un-proffessional, and heartbroken...I realized that day that I had to do one of two things. Quit, or cope. So, I chose to cope. I had worked long and hard to become a confident, competent NICU RN, transport nurse, head of parent support, one of the team leaders for high risk....I kept going and going, without really stopping to take care of Christine. I had realized how far I had come, in only a year and a half out of nursing school...however, realized just how far I had come everywhere else but within myself. I started by forgiving me. I did what I was trained to do, and it didnt work. In the beginning I prayed, and I cried, just trying to figure it all out. I went back and forth with de-briefing counselors, on whether or not I should take care of the really sick ones....but I knew, that if this was the choice, than I would surely have to leave the NICU. I forgave myself for being so hard on me, for being what I considered "selfish". Once I got this together, I knew the best way to go from here on was to become not only skilled, but emotionally stable too. The way I did this, was by giving parents peace, and calm in the storm. I now find myself sitting on the parents side when the M.D. gives the aweful news of the head ultrasound, offering them a hand, tissue, and comfort. And when it is decided, I give them all the time they need. I explain everything I am doing, and why. I recently went to the head of neonatology and demanded a morphine drip for continuous sedation during extubation procedures, I encourage skin to skin while the baby is alive, and dressing their tiny ones, bathing them etc..... Yesterday, 650 gram "Amanda", went to heaven on the chest of her mother. Skin to skin with nothing more than the morphine drip line, a darkened room with a single light on in the corner. The monitors were muted, and I threw a blanket over the red alarm on the top...turning the monitor towards me...the last thing I wanted them to see was the blaring heart rate of 30 and sats of 25.... Before I withdrew the ETT, I shared with the mother how I felt that this was the way any baby should go to heaven...surrounded in the love of her family, held by her mother, her father and in such a way, her face was so relaxed in calm peace and comfort, and how her heart rate had never looked so good...and before removing the ET, cleaned her face gently with baby oil to remove that sticky tape, and asked parents once more if they were ready....wiped the tears from her mothers face, placed my hand on her fathers hand and slowly withdrew the tube....allowing even, this nurse to drop a few tears too. The rest of the family in the background of the room, in silent calm. I realized yesterday, that I had arrived in this place of peace...one that I had been longing for, for such a long time. It was 5 pm. I never left the family except for the last hour, after baby was wrapped and family was holding, giving the parents quiet, and told them I would be right outside the glass doors if they needed me. The grandmother of the baby, mother of the mother, brought me a water and said to me, holding my hand "you must have been doing this for a long time, you are such a blessing to your profession, to our family, to my daughter, to my first grand-daughter, to the patients that you serve." "A long time" Is this not one of the greatest compliments one can recieve from a patient or their family? I decided to take a few hours PTO time once I had finished up my charting, I rode my bike home, and I thought about my day. I was saddened for this new mother, I thought about how hard she worked to pump the 6 mls of breast milk that I forgot to take out of the breast milk freezer before I went home. I thought about how she came into the hospital, with hope that we would have the expertise and knowledge to save her 25.3 weeker, how she hung upside down for 4 days trying to keep a fully dilated cervix from having any pressure on it, how the father and her had just gotten married..... I used to tell myself, "its not about you." I excused my placement in the situation of a parent losing their child. I was just the nurse afterall, and most of the nurses I have seen, would not have done the photos, the memory box, the skin to skin...as a matter of fact, babies have been taken off the vent lying in their beds...and to me, none of that made sense...I had grown and found a way for not only the family to go in peace, but to let myself also be in peace...which I now know is so important. Fellow nurses, we are not the center of loss....the babies are not our own children....however we are a part of the process, and once we realize this.....things can change dramatically for not only ourselves but our patients as well. When we see what we do, as giving a gift....then we know that we have come to a very, treasured place in our careers. I continue to grow each time I experience grief and loss in the NICU. I have found that loss does not always include the death of a baby. I see now, that loss starts the second a baby enters the unit...be it a full term baby for 3 days of antibiotics, or a 25 weeker with a grade 4 bilat hemorrhage.....a loss of the "dream" delivery, the television perfection of birthing balls and swimming newborns, was not given to them....there will be grief and sadness...it is how we, as their nurses handle these emotions, that will make all the difference in their hospital stay. I hope in some way that my own loss, of the perfect "Real nursing in the NICU" where all the babies live, smile and parents smiling in joy with the hopes of spending the next 4 months traveling 3 times a day with pumped breast milk, half the time missing a feeding because we had to chose which baby to change on the half hour...I hope that this loss has helped you in some way too. Please remember that grief is a profound human experience and grief and loss is not always pulling the ETT.....it is much, much more than that, and yes.....you are part of the circle too. I look forward to reading your stories and learning from you, how you have handled compassionate support withdrawl, and your ideas on how to make this tough situation, easier for the famalies and the staff. I pray that you are able to find peace in giving of your compassion...every time you give of you, truly you are giving back to yourself. Blessings, Christine,RN:heartbeat

Hi :) I am running a successfull parent support group meeting. We meet once a month, the hospital provides dinner. The hospital social worker and I have about 6 parents that come every month, and new parents who are currently in the NICU are invited to come. In the beginning we were nervous about mixing up those famalies that had a loss and those that took their preemies home.....we did not know if it would work... But it has and is flourishing. The parents have made great friends. An example of how the mixing has been a blessing.... The H family lost their baby after 32 days in the NICU, they did not come to the meetings at first, when they started to come...the H family found out after about 9 months, that they had become pregnant again.....the group gave them a huge baby shower, the H family has gone on to make blogs and give their information to famalies who may be of need in the NICU. With this, other parents have been able to see that even through loss, they have been able to build and grow....while still honoring their child lost...which is really, really important. We have a yearly candle lit memorial...and this year we are all walking together at the March of Dimes walk. Sometimes, we invite community services to come in, like one month we had VMRC services come, they do developmental assessments and community referrals, and then we had a countywide rep come in with information about post partum depression. Sometimes we cry, always we laugh...and we learn from each other...I can not tell you how much they have taught me as a NICU nurse. I hope that this helps...maybe you could ask to begin a group? Feel free to PM me if you would like some suggestions on how to get started.

Hi :) As far as the "incident report" issue...we have to file them when we have this issue too...matter of fact had this happen to me for the first time a month ago...(kid was not in kangaroo, as it of course, has never happend during KC), and it is listed under "self extubation"...because of the need to re intubate, which could cause trauma, and you do have vital sign changes...it is an incident...depends on your hosp policy. We write incident reports for so much stuff! As far as it being your fault...please do not blame yourself....it happens...to all of us, and it sure makes you feel aweful....but like Steve said, just a teeny, tiny movement could extubate. Was your tubing propped on something that could have moved the tube as it moved? Or maybe your tube needed to be propped when prone...I love putting my tiny ones on their tummies...they love it too...but I noticed that you have to be really careful with the position of the tubing, kinks happen easily too. Also...maybe was not extubated...was there a clog in the ET tube when you removed it? sometimes those excretions clog up the tube...or the baby "clamps" down...I had this happen to me, we used albuterol right into the ETT, to open the lungs up...depends on your docs and your policy if this is allowed. Dont feel bad, we all have been there...keep learning, and growing...and talking to your fellow NICU ers :) take care, Christine

Hi there :) As far as autonomy....we are very autonomous here...again I work in a community level III NICU, so our docs are more laid back than the big tertiary centers, and teaching hospitals. We have 2 great neo's...but...you got to be on your game, because although they are on call 24 hours...they are not at the hospital. Do you work in a teaching hospital? I know in the UK, as well they have visiting nurses...in our area, we do not do this, but I do run the high risk follow up clinic where kids come back every 6 months for 3 years for follow up and referrals. Technology...I am sure that are close to each other....ventilator care, etc should be about the same. I did go to a 6 week training at University of SF and had a preceptor for 3 months after that, as well as was sent to advanced practice nursing course, and intubation/transport certs but this was after 1.5 years in the NICU. What area are you from? I have a friend who is from England...she worked over there, and here and is now at a HUGE tertiary hospital in San Diego...if you wanted to ask her, she would love to email you I am sure...if you wanted to PM me, I will give her your email with q's for her. She is very experienced, 30 years I believe in the NICU. Courses are offered by the different area hospitals, I know our NANN courses were offered to other nurses interested...the universtiy hospitals have out reach programs, for sure I know that UCSF has one that I attend every few months. Also, you should check out www.nann.org this is the national assoc. for NICU nurses, there are refererance books and info here, a great, great resource.

How do you all do your trophic feedings? ie; continuous feeds, q3 so many mls per gram etc? We had a 670 gram preemie getting 2 mls q3...had no residual for full 12 hour shift, girth stable, no color change in abd etc...then first feed for night shift? 4.5 ml residual, bilious....black tummy 8 hours later....out to surgery for NEC reduction to bowel One doc, mad at the other doc for ordering the feeds so soon. Baby was 5 days old, only 2 days past recieving Indocin, and despite nurses questioning the orders, doc insisted upon trophic feeds... Just curious how other places handle their trophic feeds. Thanks all, Christine

Hi everyone :) I am sooooo glad that I found this forum. I have found that it helps to see that others are feeling the same way as you....you do not feel so alone anymore. I was just wondering..... I have been a NICU RN for 2 years....and was given the best mentor and preceptor oppurtunites...which pushed me, and my training...only 4 months out of nursing school...I was taking care of the sickest babies, attending high risk deliveries....technical skills? awesome. Learning, growing...challenging....but...... Sickest babies=some that do not make it. New nurse with heaven bound infants=lots of sleepless nights. I had a 36 weeker, a day after she started having high residuals, was put on a repogle suction, NPO, antibiotics etc....and 2 hours after I took report.....we were coding her, with the parents in the room. Epi x3, chest compressions for way longer than NRP suggests trying....it was extremely difficult...continues to be very hard to talk about..... I LOVe being a NICU nurse...I am proud of how far I have come...yet...I know that this situation effected me greatly. I thought I had gotten through it...until...I went to Christmas mass at the Catholic church by the hospital, and the Bishop was the priest that had come when we called him to the unit...and there it came up again . It has been about 6 months. For you, "elders"....was it like this for you in the beginning? Does it get easier? Am I normal ? Thanks for your response and your companionship... Christine

hi:) I have only worked here in the US, in a level III NICU, community. I do not see anything wrong with contacting the nurse recruiters and asking for a look around. In my research, I do know that there are quite a few differences with our units versus UK units. Kangaroo care, and family centered care are happening over here, however not as structured yet as yours probably are. You all have Forever friends I believe, which is comparable to our March of Dimes programs...maybe you could look at the March of Dimes website and that will give you a little information... www.marchofdimes.com Good luck to you...and welcome :) Christine

I went to a memorial of one of my primary preemies...Lilly was her name. It was soooo beautiful, in the backyard of her parents home. I was the only NICU nurse there, and they made me feel so special...they had a chair set up in the family area...and on the table where they had her pictures, and her little mementos was the little card that I had placed on Lilly's bed..."as all princesses do...please, nurses make sure that you keep lip gloss on my dry lips" (tear) it was so sweet....lots of flowers, and bubbles....I cried and cried during the memorial. I was glad that I went even though it was really hard, but seeing just how much it meant to Lilly's family, and how much they regarded me....so touching and something I will never forget. I think that we should go when we are personally invited...yes it is hard....but....

Hi all, Just wondering....what do they do with your staff when you have low census? Cancel you? FLoat you? Let you be over by 1 nurse? And for those that have to float...where do they put you? Just curious, Thanks, Christine

Our census is WAY low for us too...yesterday we only had 4 babies...2 1:1s on the vent and 2 grower feeders.....they are doing some crazy stuff with staffing too....instead of allowing people to request cancel...they are making everyone come in and forcing them to orient to post partum (no offense pp nurses.....I absolutely LOATHE going to PP)....out of curiosity, what do they do to you all when your NICU census is low? Float? cx? So...send us your babies everyone :) hehe Oh...and Merry Christmas everyone! :)Christine

This is NO lie...I swear on the bible.. This mother had a few babies who had..very unusual names...but the last baby she named, had social services come in and remove part of it...so here it is in full...before ss came in...can you figure out which part of the name they asked her to consider before the birth cert was drawn up? bikini wanna halta top, top notch, booty shake, no erase Jordan (last name not given due to the all mighty HIPPA) NO LIE...all her kids began with "bikini wanna"

"at the end of the day faith is a funny thing. it turns up when you don't really expect it. it’s like one day you realize that the fairy tale may be slightly different than you dreamed. the castle, well, it may not be a castle. and it's not so important... happy ever after, just that it’s happy right now. see, once in a while, once in a blue moon, people will surprise you, and once in a while people may even take your breath away." dr. meredith grey hi :) i borrowed this saying off of one of my parents blogs....you will soon find that your explanations do not make much sense to those who have never held a 2 pound miracle fighting for their life before....i just tell others that miracles come to us ready for the fight, however tiring quickly due to things not within their control....tiny bodies, equal tiny systems, and fighting the biggest battles... without the arterial line monitoring their blood pressure, the uvc allowing fluids and life saving drugs, without the tube giving the tired lungs air....yes preemies, feel pain, and yes it has been proven that they remember....even proven that the smell of an alcohol swab can begin the pain response.....so as nicu nurses...we need to know...that the things we do are felt...learning how we can make these interventions less painful or tolerated easier is very important. http://www.nature.com/nm/journal/v6/n9/full/nm0900_971.html an article you may find interesting :) welcome to the nicu, be patient with others...and know how much of a difference you are making in the lives of your patients :)