ittybabyRN

I don't think this person realizes how dangerous this could be, you don't just "learn" icu while you have a crashing patient, the drugs, drips, procedures and even certain scopes of nursing practice are very different and doing so would put these patients, as well as nurses license in extreme risk

We change drips every 72 hrs, if we think the kid will bottom out we start the drips running on a new pump for a few minutes and then change over quick

I would also like to know. I am a new grad...well I guess I was a year ago anyways while I love my unit I get pretty bored with the feeder/growers and am looking into travelling/working elsewhere eventually. Would love to work in a level 3 that is mostly just that and sends kids out when they reach a certain stability

We also start with bolus feeds and see how they tolerate it. It can also depend on the baby's attending on how they are fed goes too. No set protocol

I work in DC in a 54 bed level 3c unit. We have 46 private rooms and 2 4bed pods. We have level 2/3 mixed (no stepdown or intermediate area). We often have 1:1's, the usual is 2:1 and rarely we have 3:1. A 3:1 assignment would be feeder/growers only or feeders mixed with NPO's but no vents/frequent labs etc, and we only have 3:1's when we are short or have quite a few critical pts. Ratios are based on how acute the pt is or how "needy" a pt is. ECMO/HFOV/Cooling/PPHN kids are generally 1:1. Other than that it depends on what the kid is doing to warrant a 1:1 assignment. We very rarely have 2 vents paired. Admits are usually paired unless the kid coming is really sick and then the admitting nurse would have to give up her babies.

I work in nicu and some of those supposed to still be fetuses have the same type of skin. We use replicare as a barrier under the tape and a special adhesive remover that unsticks the tape from skin to get it off w/o tears

I'm pretty sure that's something you need to claqrify with your pedi but I will tell you, I work in nicu and we use albuterol nebs all the time, not sure about the others though

I don't think we have any policy, just depends on how acute/busy the pt is. Any hfov/cooling/ecmo/cvvh, pd kid will be 1:1. Kids on pressors may be paired depending on how stable they are on their pressor. We pair vents if they're stable as well and kids going to/having surgery are also paired if the procedure is expected to be minor

Movies?! Yipes! I work in a private room unit and not even the parents get to watch tv!

Once in the nicu always in the nicu, I have spoken to a few nurses where I work since I've only been here a year, kids never get tx to picu, if they are d/c and readmitted and no longer nicu material (over 3moos) they will go to picu but kids never tx from nicu to picu...we just celebrated a first birthday last week...

We have PA's. They work on the same team as the NNP's under the same attending and have the same scope of practice (at least I haven't noticed any difference between having an NNP baby or a PA baby)

We had to cross train to PICU and CICU as soon as we got off orientation (6mos). I have to say, I liked the CICU better and hope to try working there someday, and when I floated to PICU they gave me a 14 year old!:uhoh21: I did not speak up and while he was a stable walkie talkie he did have a clotting disorder and was on heparin therapy which is why he was in ICU, I can tell you I have never had a more nervewracking day. Usually they do give us babies or our grads but they had 4 of us from NICU that day and they wanted to give me the most stable kid they had left over...next time I will speak up, I can code a baby but that 14 year old was totally out of my scope

this exact thread appears in the NICU forum: A Day in the Life of a NICU Nurse - Nursing for Nurses

This is a little off topic but something I have been wondering for a while...I work in a NICU and we don't hang blood with anything, we just run it alone as is. I have floated to the PICU/PCICU but did not at those times ask the question...at what point do you start hanging blood with NS? Is there a certain age, weight? Just curious, thanks!

What I did was start with looking at all the states major children's hospitals, teaching hospitals and hospitals with large women/infant programs. Typically if you start with the area of the Children's hospitals there is likely to also be a large adults hospital nearby and those usually have NICU's too...and then pretty much where ever you figure out where the large children's hospitals and teaching hospitals are, there are usually a few other smaller hospitals in those areas as well. Looking for smaller more suburban hospitals will be a little trickier

Our unit does similar things to yours, every experience is different of course. Last weekend I experienced my first patient death, it was very very sad but looking back probably one of the better experiences I, and her family could have had. She was full term but when her mom went for an induction the FHR was 20, after the stat csection she had no HR. She was resusitated and came to my NICU for three days of cooling but her EEG and CT were very poor, after rewarming she had only minimal brain stem activity and her parents made the heart wrenching decision to withdraw care and allow a natural death. They had two days to enjoy her. I encouraged them to bathe her and I took many, many photos for them. I asked if they wanted to assist me with the things we often do after a baby has died - hand/foot prints, 3d hand/foot molds and they did assist with those things because each thing they got to take part in was one more memory for them to have of their daughter. We cut locks of hair and filled up the memory boxes we provide. They had her baptized, chose a stuffed animal for her and for her siblings and were provided with pamphlets and small books on grieving for them and their family. They had the opportunity for all her family to come in and say good bye and then quietly, peacefully two days after support had been withdrawn she died in her parents arms. Her parents stayed for about 2 hours and then they left their arms filled with the memories they had collected of their baby. Once they were gone I took a few more photos and emailed them to her family later. Then she was shrouded per our hospital policy and swaddled in a blanket. We have a basket we use to transport infants to the morgue but I think it's kind of obvious if you're carrying it, I chose to carry her in my arms with a blanket over her and my shoulder. Our morgue is also pretty far from our unit and its impossible to get there without meeting someone on the way but I found it nicer to carry her. Our unit sends a card to families about a week after the baby has died, many people from the unit, whether they cared for the baby or not will sign it, they do mean a lot to the families.

I live in Arlington and love it. I live near the courthouse metro stop. I work at Childrens and I alternate between driving and taking the metro. Driving takes about 20 minutes - I can leave at 615, grab coffee at starbucks and be at work by 650. If I take the metro it takes longer, I usually need to leave about 555, get the 605 metro to brookland (orange line to red line) then from brookland take the shuttle, this puts me at work at 645. Either way I dont think its a bad commute, I don't mind the metro, sometimes its nice to just relax, sip coffee and read on the way to work

I think that's what we use too...don't know the exact name, we call it a "kids kit" with a "pigtail" attachment

13lbs, 8oz! Giant omphalocele is what landed him in the NICU (so he was a csection). However, poor kiddo, it was easy to forget he was just a day or two old being as big as he was, it was so hard to hold him up to burp him or feed him having to support so much of his weight! (compared to other 13lb NICU babies who are usually months old and holding their own heads up and whatnot)

Hugs :hug: I experienced my first death today as well. I've been off orientation about 7 months now and while I have helped others with bearevement cares this was my first patient death. She and her parents broke my heart. She was full term, induction, went in for induction and couldn't find a HR. Stat csection, no HR at birth, 30min apgar was 3. Cooled for three days with a very flat EEG, we did a bedside Cat Scan that also showed severe, profuse damage. She had no reflexes, pupils had no reaction. But her intact brain stem kept her breathing for almost 2 full days after we withdrew all support. I had her during her cooling time on Tuesday, then yesterday where I spent most of the day helping her parents however I could, we did hand prints, footprints, hand/foot molds, took pictures, gave her a bath. By the end of the night her parents were ready (she was having very frequent and severe A/B/D, often dropping her HR to 10 and self recovering), but she hung on until about 3pm today. I have to say, the most horrible sound in the world is the sound of a mothers scream as her beautiful, perfect 8lb infant is pronounced dead. I don't think I will ever forget that sweet sweet baby and her wonderful family. :redbeathe

Heard from a momma at work: place an egg above the baby's crib to prevent teething pain...she tried to do it too but nurses wouldn't let her keep the egg in the room

Interesting, I've never heard of a PPHN-er on milirinone (we do have the older, pulmonary hypertension kids on it), and we would have dopamine/epi on if hypotension is also an issue (which it was)

ahh we've got two "geriatrics" right now haha, both 10 months old, both 26wkrs, both with pulmonary hypertension, trach, one with a g-tube and sprinting on her trach nose, hopefully going to be headed out soon...her mom though has the room DECKED! toys, games, even a stroller even though she can't leave her room, mom is always in there with her playing, she is so developmentally appropriate and has many many primaries who I believe like to get the chance to play with her. The other one...well her mom would have her headed in the same direction of the other one if she could, and she often is there playing with her, the problem with this kiddo though is she still has her frequent unstable episodes and most of us believe one of these days shes just going to up and die during one of her moms play sessions :-( But can we stop it? Not really, if shes awake her mom is waving things around in her face, bouncing her on her lap, shes got pretty bad 3/4 pulmonary veins stenosed, she spent literally the whole 2 months before she got her trach coding, however if her mom is not around we are typically not playing with her, the poor kid just sleeps and sleeps whenever she gets the chance

Thanks for that info! I am a brand new NICU nurse off orientation in Feb, I work at a large teaching hospital so I get to listen to the arguments that occur between the older nurses and the newer docs regarding certain treatments, the nurse who had this kid yesterday was one of those older nurses who kept trying to get versed drip, I had asked her why we didn't use fentanyl because I know it is widely used in neonates in the CICU but she told me they used to use it but dont anymore....however she preferred it. I think in some things on my unit it can be a constant struggle between what the new literature is suggesting and what the older docs/nurses think is appropriate. I am just wondering if this kiddo had been sedated more if it would have kept him off ecmo. And initially yes he was on nitric as well as conventional vent...did go onto the oscillator a few hours before ecmo

Hello! I was just wondering what other ecmo-utilizing units to do to best manage PPHN before it reaches that point? We had a kid this past week who was doing pretty well until he "flipped" during line placement. I heard later that day that nurses were requesting versed and the docs didnt want to give it because they are trying less and less to use versed to prevent brain injury from it, we also do not use fentanyl d/t rigid chest syndrome, so basically the options left are morphine, Vec if we really beg and think the kid will benefit. I didn't have the baby so I don't know all the details but he did end up on ECMO though the previous day it seemed he had turned a corner in the right direction. How do you manage these kids sedation-wise on your units, any other managements you use?