EmilyPeruana

yes, i have the nann article that was posted in that thread. just looking for additional ones. and information on exact practices/procedures in other units as i develop a proposal for our unit.

I'd use OG tubes on infants who are on the ventilator (easy to tape to an ET tube) or those on very high flow vapotherm or CPAP. With CPAP, you need a good seal with the mask or prongs, and an NG tube wouldn't fit or wouldn't allow an appropriate seal. With very high flow vapothem, like 5L+, you wouldn't want an NG tube to occlude any of that high flow in their nares or to cause the cannula to stick out and prevent all of the flow from entering through the nare. I would suggest either using a very small NG tube (6.5F) if the infant is large (vs an 8F) or using always an OG. If on much lower flow or just nasal cannula, NG is best b/c they can suck better on a pacifier and would be able to practice with a bottle better.

Is YOUR unit using colostrum or breast milk for oral care since some VAP care packs have been discontinued or the companies manufacturing them have gone out of business? I've read some articles recently (one from nann) about using colostrum and EBM for oral care aimed at VAP. I have pitched the idea to our nurse educators and one attending, and I have their full support. I want to propose it to our chief of nurseries next week. Does anyone have any other articles or studies? Also, if you use it in your unit, what is the set procedure you use? Do you swab it around their mouth, then suction? Do you watch it down with sterile water? Do you swab the breast milk in their mouth and then swab with sterile water so it won't leave their mouths sticky? How much do you use? Do you suction afterwards? Do you send parents home with a few syringes? I'm really excited about this proposal, especially since I've only been a NICU nurse for 2.5 years! I really think the unit will be accepting of this, especially since it's natural and FREE! It should also serve as a further encouragement to moms to pump since it may help prevent VAP! Please post any suggestions/responses to the above questions! Thanks!

After about 30 min with my jet patient, it all came back to me...yesterday, i was given a patient on an oscillator, so i must have been doing things right!

http://www.nann.org/pubs/enews/sept_09.html

i would think you could find something at vandy...especially if you start applying now to start sometime this summer...if not, then in the fall...there are lots of students at vandy who work at vandy also...maybe nurses getting their masters who will graduate in the fall/end of summer and will quit... vanderbilt.jobs/

my husband and i have a 2BR, 2BA, 1100 sq ft apt for almost $900 a month. not awful. nashville homes DO cost more. but if you live a little outside the city (murfreesboro, spring hill, smyrna, etc), cost of living goes way down.

i think vandy starts new grads at around $19-ish? maybe $20??? at most right now. benefits are good...insurance is good, especially if you see vandy docs, it's cheaper....Rx's are cheaper if you get them at vandy pharmacies too. you get local discounts on movie tickets, cars, apartments, cell phone service, etc. great tuition benefit if you continue education with nursing...esp if you do it at vandy...but must be working full time...covers at least 12 credit hours a year if in nursing (like doing your masters). their benefits help cover up the lower pay!

the closer you are to vandy, the more expensive it is...but be careful, b/c you dont want to be in certain areas where prices are nice but crime isn't...there are some apartments in bellevue that are nicely priced and in decent areas...royal arms apartments in green hills is older and ok but in nice area and about 10 min away...the landings in brentwood are decently priced and about 20-25 min away (near shopping and restaurants but quiet)...you have your pick!

we set our babies' o2 sats limits at 80-95% if they are on o2, especially if they are less than 32 weeks gestation. the target sats of 85-93%. this is to protect their eyes from rop. this is backed by studies. i will post them at the end. if the baby is on room air or 21% o2 on flow or ventilator, then sats should be at 85-100%. certain cardiac babies have limits set at 75-85% older babies may be set at 90-100% [color=#003399]chow lc, et al. can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? pediatrics 2003;111:339-345. [color=#003399] [color=#003399]tin w et al. pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. arch dis child fetal neonatal ed 2001; 84: f106-10. [color=#003399] [color=#003399]penn js, et al. the range of pao2 variation determines the severity of oxygen-induced retinopathy in newborn rats. invest ophthalmol vis sci 1995; 36: 2063-2070. [color=#003399] [color=#003399]askie lm, henderson-smart dj. restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. cochrane systematic reviews. http://www.nichd.nih.gov/cochraneneonatal/askie4/askie.htm

Hey fellow NICU nurses, I've been primarying a trach baby for about 6 months who will be heading home soon. We are about to get a new bunch of new nurses so they will be orienting with her (with other preceptors) since she is our only trach baby. So I was going to request some jets because I've had just about everything paired with her except a jet. Please oh please oh please. I need a quick review course on jets to make sure I've got my head on straight. They will be one-to-one assignments for me (since someone else will have my primary patient). My trach baby has been on the vent all this time (on MMV mode), so vents are NOT the issues. Neither are micropreemies or the sickest of the sickest (b/c i've been through it all with my primary). But I need a run through on the positioning of everything inside the isolette, which tube points up (not referring to the ETT), backup rates to help recover from bad spells, understanding all the numbers again, etc (servo pressure, etc.). I'm sure I'll be great once I jump back in there, but it's been a while! Thanks guys! Y'all rock!

wanna know the easiest trick to doing it - GET A FRIEND. i'm the one who always takes the hardest babies or gets assigned the most complicated chronic ones because i dont mind them and have experience with them. but i still get another nurse or RT to help me when it comes to changing a trach (even though i can probably manage alone) or flipping a baby or repositioning... always ask someone for a hand...even the most experienced will ask for help! plus, you dont want that tube coming out or being pushed down that right lung and not expanding that left one at all! :) good luck! i'm sure you're doing a fabulous job! :)

we do NOT filter lipids. we do filter tpn. we clean all ports with CHG prior to administering meds or flushing. we clean the port with CHG 5-6x 360*, waiting for it to dry is annoying, but we've broken our own BSI records. we replace lipids tubing/buretrol qd, replace tpn and entire line/port system/main port on picc/broviac/uvc q3d. we do entire line changes with 2 people - 1 sterile, 1 clean. clean person connects lines and flushes through ports of our "3-way manifold "(or 4-way)....sterile person sets up everything and connects entire setup to the cvc... has worked for us so far. feel free to email me. [email protected]

we haven't been able to get biotin yet but our adult units and picu have it so we occasionally call them for it...but i just read an article about using EBM b/c of it's bacteria-killing abilities and everything...i may present it to our mgt this week and see about adopting it as a policy!!

we've had some unusual back and forths with our census too...usually we are just low in the late summer (we have a capacity of 82...in the summer, we are in the low 50s sometimes)...but when h1n1 hit, we seemed to be low while the rest of the children's hospital was busting at the seams...we've kinda stayed on the low end for a little while...hoping it'll pick up soon!!!