heartwort

I love that site. Great way to get caught up on some CEU's when you've got some downtime at work and it's better than going to amazon!! Here's another site: http://dortoms.com/nicu/nicu.asp The Cheat Sheet is pretty cool for new nurses the site has a nice developmental focus.

This is true but in my experience there are times when a parent or doc is the first to touch a child and that is not when you want to be out of diapers. I think if you use the last of something you should replace it. Some of this might come down to the customs of the unit however. Some units might customarily stock at the beginning of a shift where as others might at the end, or as needed. There have been times I've been blessed to work with techs who do a great job stocking. Which brings me to another pet peeve: overstocking. A micropreemie who's almost graduated out of teeny diapers doesn't need a whole package stuck in their drawer. A baby who's only going to need one IV doesn't need 5 catheters at his bedside. etc. etc.

I don't know of any NNPs that work in a clinic setting. They can have roles other than clinical in the hospital but that's usually their focus. If you know you want cardiovascular I'd consider starting with that and then working your way into Peds. Cardiac after you've got a little experience under your belt. It will make you more rounded.

I forgot about sumps/replogles. The ones I've used are marked every 5 cms. Weighted tubes (usually placed in the duodenom) aren't marked either. A good way to verify those tubes for sure is to measure from the distal end to the insertion site.

I listen. Your not detecting "clear and equal" but you can hear decreased vibrations in an area that is atalectic, it can raise red flags for pneumos and if the left side is down your patient might be right main-stemmed. Sight and feel can be of limited usefulness in very small babes as it takes very little to make them vibrate from head to toe. Listening is just one more piece of the big picture. I agree with pausing (not disconnecting). I do it at least once a shift to do a quick assessment of heart and bowel sounds.

Thanks for reading. I hope our nit-picking is useful. It's the little things that make a good nurse and there is a lot you can miss in orientation. (Another of my pet peeves: slack orientation programs.)

I'll second (or third) that. But even more so I don't like it when kids having procedures done aren't contained. I can't say how many times I see a nurse putting an IV in holding on to a limb for dear life while the rest of the baby is flailing all around. It's so easy to take a minute to swaddle the rest of the baby. Makes the IV easier for baby and nurse as well.

We've all got them. Those things we find that just get us riled. Perhaps reviewing them will help newer nurses. Perhaps writing about them will just let us vent. Here's mine: OGTs that aren't in far enough. The OGT may be in and secured where it has been but the baby has grown. Nurses check placement: push in a little air, hear the sound over the gastric area, aspirate and find no aspirate. They also don't get the air they pushed in back but since they heard the air they think the tubes ok when in reality its just above the sphincter in the esophagus. Put the tube down another 1/2 to 1cm and then you get back the air, and possibly a large amount of residual that was being missed before. If you don't get the air you pushed in back, you have to ask why not!

I use a skinny piece of pink tape at the insertion site. Pink tape sticks well. You have to watch for slippage on babies that get slimy. I have found a piece of transpore tape in a baby's mouth before when it was used to mark an OG tube. Tegaderm and transparent bio adhesives will allow slippage pretty easily. Just about all tubes are marked with cms these days. There's nothing that beats checking the marking on the tube every time but it only makes sense if nurses document the cm marking each shift for the next nurse to check against.

I've done kangaroo care with babes under a kilo. Lines and tubes shouldn't be the issue so much as if the baby tolerate the move. I wouldn't move a kid on vasopressors if I could avoid it. Moving a baby with lines and tubes just takes some planning and preparation, and plenty of hands. Measures need to be taken to not stress the babe out - quiet, low lights, etc. Think of the service you are doing to that baby and parent and how they will benefit!! I've seen critical babies have their best shift after a couple of hours on mom or dad's chest. Take advantage of the honeymoon period if you can. It may be the only chance parents get to hold their child alive. Here's a link that talks about how to kangaroo care a critical babe: http://dortoms.com/nicu/kangaroo.asp#kc

The last couple of units I've worked in have been similar. Some variations: Grandparents can visit if their on the 'list' without a parent or banded support person present. One unit required visitor's where a gown; one did not. One unit siblings had to be over three; the other siblings under three could visit if there was a second adult there to look after them. There was flexibility with this. Mom's of twins where one twin was already discharged were allowed to bring that twin in when she visited the twin in the unit. All siblings under the age of 14 should have their temps checked. Other visitors have to be accompanied by a parent (or banded support person) and were limited to one at a time. Other visitors have to be over 14. One unit let parents in during report; the other did not. There's something to be said about unit culture and how policies are interpreted. For instance, most units will include in the policy that parents may be asked to wait or leave if a code or sterile procedure is happening but some not so family-friendly units will take that to the extreme. I've seen parents wait hours to come in and be held off because the nurse was busy with another patient. Inexcusable in my book.