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  1. IvoryLena

    Do you filter trauma blood?

    How long does that generally take?
  2. IvoryLena

    Do you filter trauma blood?

    No, I've never seen BB prepared syringes for neonates anywhere I've worked. I filter the blood into a syringe and generally run it over a pump or hand push if needed. But lately since attending some deliveries I noticed people drawing straight up from the bag. I didn't know if this was a common practice.
  3. IvoryLena

    Do you filter trauma blood?

    In a code do you generally filter trauma blood or just pull it up straight from the bag and hand push it?
  4. IvoryLena

    Short gut babies

    Ive read about a TPN that actually has saved many short gut kids. It's not as harmful to the liver, but we dont really use it in the USA unless the doctors really make a effort to get it. There's a handful of hospitals that use it, I think it's called Omegaven. But alot of parents have posted saying it saved there kids lives.
  5. IvoryLena

    Longterm outcomes for kids with IVH

    Hello everyone, I'm taking care of a baby with grade 3 and grade 4 IVH. I'm trying to stay hopeful but I keep hearing and researching conflicting outcome data. One nurse says "oh ive seen a ton of kids with worse than that come out fine" then I hear "I've never seen any come out normal". Even with research data on study will have completely different outcomes than another. Has anyone else have a story were the baby was somewhat normal, mabye in a wheelchair, but was able to talk or attend school or anything. I don't want to give parents false hope, but if there is hope than I would like to keep that little bit of hope alive.
  6. IvoryLena

    Smart pumps = Stupid pumps?

    We have the smart pumps with the medication library in it, so it tells you the time/dose range for KG. We are required to use the med library rather then ML/HR on my unit. So My vent is this... nurses are putting up let's say a med that requires a hour to infuse on a infant
  7. IvoryLena

    HFJV vs. HFOV

    We use jets but rarely. All the babies I've seen on them have been close to term or term kids and have PIE or PPHN. More often they use for the PPHN and they add nitric. You also have the use the convetional vent along with it to give that big breath every once in a while, but that's all I really know.
  8. IvoryLena

    Preceptor woes

    Sometimes preceptors views are different from yours, no need to question yourself. My preceptor was horrible, so much so I had to ask to be switched half way in my training. Afterwards I found out I was the 4th person who asked to switch from her. So if you don't feel the same way, no biggie. However as far as ethics are concerned, they play a huge role in the NICU. Here are some examples I have had... 1. Baby born with omphalocele, now has trach, frequent infections, bilateral grade 4 w/ PVL, seizures, desats to 20's every other hour. Saw doctor walk in and tell parents "Your baby is fine, he's going to walk, talk, and be completely normal." Parents turn to you....Will my baby really be okay? What do tell them? 2. 19 week gestation baby, doctor says your baby is doing well to teenage mom. Mom asks you why babies legs are turning black and if they'll be able to fix them? What can you say knowing that the doctor should have never even put the poor mother through this. A 19 weeker? I dont even know how he intubated. 3. 23 week gestation, kidney failure among everything else going on. Baby has swollen so much, stool is now bursting from it's umbellicus to the point we had to put a ostomy bag on it. Mother doesn't come to see the baby says it's too sad to see. It's your turn to take report and you have this child. You feel guilty moving the poor thing, you wonder why ethics committee is doing nothing. I wanted to refuse this child, but then you run the risk of being fired. Mentally you want to call the mom and say "Get in here and end the suffering!!!!" but again you get fired and lose your license. I came from MBU, GYN, Lev 1 NICU and believe me, I never faced such ethical issues like these anywhere but the NICU. I find one of the best ways for me to deal with situations like these is refering the parents to speak with a doctor who you know will be truthfull in a nice way like... "Doctor XYZ knows alot about long term outcomes with children who suffer from XYZ, I would suggest speaking to him/her." And if it's a situation I can't explain or give off to the doc, I simply do the best I can as a nurse for the child and pray. But sometimes you will still have ethical dilemas and have to live with them. I dont think I will ever forget these children.
  9. IvoryLena

    why bolus and bicarb?

    Thanks everybody, It makes more sense now.
  10. IvoryLena

    why bolus and bicarb?

    Also, We were treating her just so she could get through the night so the family could see her in the AM. Fortunatly, she lasted untill the family got to say their goodbyes and then passed.
  11. IvoryLena

    why bolus and bicarb?

    The Ph was changing from 7.0-7.1. She did have third spacing and she had no urine output. Her heart rate and blood pressure was fine. I just felt like, what is the point of filling this poor thing with more and more fluid. Not to mention she ordered it as a direct result of the bad gas, so I would assume she was attempting to treat the gas and not another issue. She is a fresh out of school nurse practioner so mabye that had something to do with it. I really cant remember what her electrolytes were.
  12. IvoryLena

    why bolus and bicarb?

    I had a very sweet little baby who was born with gastoschesis, unfortunately, surgery was unable to do anything, so we were doing just comfort measures. she had severe acidosis so I was ordered to give 20 ml bolus(no change), then bicarb(slight change), then bolus(no change), bicarb(slight change), and another bolus NS. My question is why would giving NS boluses change the metabolic acidosis? and why not give the bicarb first? Blood pressures were stable through this whole time even high as you can imagine why. I did ask the doc but she only gave me a vauge answer about blood pressure, am I missing something? This was the first time I had to give bicarb, was an admission, and post surg pt. I was so busy with this child and another child I had, and I was alone in the cluster! Can anyone please explain this to me.
  13. IvoryLena

    Should I stay or should I go?

    Ok so I work on a mother/baby floor currently and have become increasingly bored with the work, this is the only nursing job I have ever had and have done it for a year and a half now. I applied at a different hospital that has a NICU internship program. I spoke with a woman from HR yesterday that told me I could not get a PRN rate if I accepted the position in the internship. This basically breaks down to...1. I would be making $4.50/hr less 2. The hospital is an hour away so I would be driving 20 mins more than my current job. 3. I would be working 3-4 days a wk, depending if I stay 2 days a month at my old job. 4. I would have benefits and PTO 5. I would have to sign a contract for a years worth of work, plus training which is 6 months time. I'm still debating what I want to do. I really want to do NICU and this is the only hospital that has a good internship program in my area. It is also a very busy NICU, so I would get much more exp than other hospitals. I think if I take the lower pay/more days/higher stress/longer drive/ect. now it may really payoff in the long run. At the same time I think, "are you crazy all that for less pay!" I think if I can deal with it for a year and half I could always come back to my current employer and get the PRN rate again in thier NICU. My current employer will not train any mother/baby nurses for NICU now because of "bad experiences in the past, the nurses didnt work out.":banghead:
  14. IvoryLena

    Could I have done more?

    Thanks for responding and explaining things to me, I feel much better now. Baby is still in the NICU but doing MUCH better and I saw mom who is doing well too. I check on him everyshift I work. At first he was on an oscillator, I think thats what they called it?, but now hes responding well to new treatment so they took him off it, but he's still on a vent but their trying to ween him off.
  15. IvoryLena

    Could I have done more?

    Im a new nurse only three months exp on the floor of a low risk mother baby unit. I got a new admit to the floor a Csection mother and baby. Baby was checked out in NICU while mom came to me. After assessing mom I got baby from NICU, baby was pink, normal, with regular resps. While attempting to get baby to breastfeed baby spit up a small amt of fluid and blood, I assured mom this was normal from a C/S baby. Then an hour later after eating baby spit up a little more, baby was fussy so resps were elevated but no distress noted. At this point vital signs were due again in two hours. When I went back to the room, the room was ice cold. The family had turned the thermostat down to around 65. I immediately took baby vitals temp-96.5, p 140, resp 50, and baby wasn't breathing regular, I asked the mother how long the baby had been breathing this way and she said she didnt know and that the baby made some strange sounds and she thought about calling me but didnt. I pulled baby into the light and saw he looked different. I took baby to a charge nurse and said " look at this baby it isnt breathing right." The nurse looked over the baby and agreed and told me to go straight to the NICU and she would call ahead and let them know I was coming. When I got to the NICU the baby was turning blue, they immediately gave baby 100% oxygen. baby pulse ox was at 60, after oxygen it went to mid to high 80's. Then a team of nurses and neonatalogists went to work while I stood there trying not to cry. The neonatalogist pulled 7cc of blood from baby's stomach and believed it to be moms blood and told her that. However after x-rays turns out baby had a pneumothorax. I have a trillion questions racing through my head right now. If baby's pulse ox was 60 did I walk in right at the exact moment he was crashing? how long can organs survive with oxygen sats that low? Can a newborn live though this without suffering life long damage? how long does it take for a pneumothorax to develop in a neonate? Its hard for me to imagin that at the exact moment I walked in the NB was taking a turn for the worse. How long could a baby survive like this? seconds? minutes? hours? Was there something I missed in earlier assessment? I just dont know what to do, Im so upset.