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We recently had 2 (from our unit) train as car seat techs, and they are available at least once a month on a Monday for the whole hospital and community. I try to refer parents to bring their car seat in on that day (at some point between them becoming less scared of their baby and the rush to get out the door so that they can, hopefully, absorb some of the information). I make the parents strap the baby in for discharge and will make a comment if the straps are too loose. Usually, we do the car seat tests in the middle of the night, and the parents are not around - we have to move the straps ourselves in order to do the test properly - we should probably get the parents to do that at some point before the test (something to look into). Maybe you could look into community resources for car seats and see if there are programs for you and some interested colleagues to attend and become certified;) Make sure you look into costs and such. If your hospital is willing to pay for it, you may have to be available to serve the whole hospital, not just the NICU.

Thanks for the input - we are trying to put together a policy because we have been seeing too many kids being stuck too many times (think 27 times between 2 kids one night, between RN's, MD, and IV team - aweful) and I know a lot of it is because the med team pushes off putting in a PICC because "look they got another PIV, they're ok" when really, the kid needs something before they have nothing, then surgery is forced to place a broviac (with minimal options for pivs during surgery) because now all the PICC options have been used up.

I work in an open area - 3 hexagonal things with 5 beds (one off each side), one isolation room, and 2 open bay with about 7 beds each (maybe about 3 feet between beds, especially with all equipment). We have always allowed parents to be at the bedside for rounds, but I don't really remember many parents participating (I work nights, haven't been on days for a while). Also, I don't remember there being that many people - usually: RN, charge nurse, maybe a student, attending, fellow, a few residents, pharmacist, SW, RT, and nutritionist. Like NicuGal, we also have discharge rounds weekly with DC planning, PT, OT, ST, etc plus others involved. There are usually 2 different teams (3 if we are really busy), and each team has a different patient list, so they try not to round near each other at the same time. We just started "including" parents in shift report (I know this is only 2 people versus rounds). Most parents who participate don't really listen during report and just ask questions when they have them during the shift, and, even though we are close proximity, I don't really see the majority of parents listening in (if they are, try to redirect - tell them that they wouldn't want other people knowing sensitive info about them or their baby, please be respectful) - we also do not have good parental involvement to begin with. I think that the unit is talking about calling parents daily, few times a week, not sure? in order to update them because many parents don't visit or call for days at a time. I do encourage parents, especially if they have a lot of questions, to ask for a family meeting - where it's a sit down with any support they want and docs/professionals from every team involved in the baby's care - more personalized and less rushed than rounds.

We had the closed system briefly, not sure why we don't anymore. We use a stopcock close to the insertion site (between the t-connector and art line set) for drawing off of. close stopcock off to fluids, draw waste with 3 ml syringe until > 1 ml frank blood, half cock to prevent bleeding out (always do when changing syringes unless drawing through smart site), change syringe to ABG or 3ml for gas/labs turn off to fluid again, draw needed amount (half cock between if need multiple syringes), then we return waste and flush line (either leaving flush or a smart site on port) and return stopcock to neutral (off to smart site port part). hope that wasn't too confusing.

Hi, Just a few questions: 1. How many PIV start attempts are allowed per person at one time for a single patient? 2. How many PIV sticks are allowed per patient in a given time frame? at a time? in a day? in a week? 3. Who does the PIV starts in your unit? Your PICCs? 4. At what point do your doctors choose to place a PICC? What criteria to you have in place for who needs long term IV access? (ie: indefinate NPO status, # days antibiotic therapy, etc) 6. If a patient has criteria to need long term access, how many PIVs does the patient need before the doctors choose to obtain consent to try for long term access? I think that's all - Thanks so much.

You know, I just learned that Tri 21 kids are prone to leukemia, but theirs is 100% curable - per our oncologist. wonder why? We recently had a Tri 21 baby with transient leukemia. Always something new to learn:)

nevermind, reading other stuff on internet - we just never heard it here

Had a patient recently, HIE, coolcap, DIC, third spacing, anuric times a few days, then less than 1 ml/kg/hr. Her serum Na was 117 - 121, Cl 78 - 82, K 3.6 - 4. I was told by the Fellow and NNP (per attending involved in case) that we weren't to aggressively correct these labs because the patient's blood was diluted and we wouldn't know her "real" sodium level until she started to diurese. Is this a correct way of thinking? I, and nurses more senior than me, had never heard of this. So if this is true, would her "normal appearing" K really be much higher? I was just wondering. Thanks.

What criteria does your scoring chart contain?

Thanks for the info. it is a sad beginning to life.

had a little one, less than a week old and diagnosed with leukemia - anyone ever see this?

We are supposed to check the pH of the aspirate, however, many of us double check via air bolus auscultation, then aspirate to check amount and pH. OG/NG continuous checked daily after feed held for 1 hour. Bolus feeds checked with each feed and meds, also check pH if the tube has to be replaced.

I mean IV's, saline flushes, ETT, etc

radiology studies, bedside xrays

We waste so much - I saw a previous post that mentioned sending supplies to a charity after a patient is discharged - just wondering how to start doing that, now we just toss it.