NICU_RNC

We are changing our practice to not routinely check gastric residuals unless other signs of feeding intolerance. For those of you who do this, before a feed how are you confirming your NG placement in an existing tube? Just checking the numbers to be sure it hasn't moved since it was placed? or checking for a bit of partially digested feed at the first feeding of your shift? something else? Thanks!

micropreemienurse did you mean bevel DOWN like the video? Would you be willing to share your policy? Thanks guys!

Also, what labs can and can't you get from the cord blood?

Yeah I guess I never heard about drawing right off the placenta. I assumed the OB would cut us a good length of cord, and we'd draw it off...or make the OB nurses :-p I showed one of our neos the video, and he had a confused look and his face and said we should just draw from the cord. We only need 3ish mLs. Any thoughts on this?

Yes I'd love the PDF... I just need to make a few more posts apparently in order to have the ability to PM. You need like 15 or something :-S Can you PM me? Thanks a million!

Hummm. I've never heard or this. What purpose does it serve to do so?

Hi there, We are looking to put in place a protocol for drawing our admission labs (usually CBC, CRP, blood culture) from the cord blood. I'm looking for how other places do it... Does the OB nurse or NICU nurse draw it? How soon after delivery does it have to be done? Just swab with antiseptic first? Best gauge needle to use? Anything you have would be helpful. Thanks!!

We don't do it because I didn't think there was any evidence supporting the practice. We just leave their open bums in the air. Anyone have a reference or resource supporting this?

We have had them for about 2 years now. I agree with just about everything the above poster said. Parents love them. We turn them off for cares and just about any time we are in doing something with the baby.

I can't remember the last time we gave Sodium Bicarb here... It increases the risk of IVH so use sparingly.

Hi, I'm trying to update the policy for our rectal irrigation for Hirschsprung's patients. We currently use a very soft red rubber catheter which really does the trick. However, in the interest of a latex free environment (and the fact that every other hospital's rectal irrigation policy I can find uses a silicone catheter), I'd like to see what you guys are using. Please give the manufacturer of the product too if available. Thank you!

Opps! Don't know what I was doing there...I meant a 1 unit/cc hep saline flush NOT 10! Sorry!

I'll gladly answer the weight question everyday. What bothers me are the parents who don't bother to call but once every couple days. Especially when their next question is, "How long before he can come home?" Well let's see...he's still on a vent...if you would have visited sometime in the last week you would know these things! GRR! I think a pre-parenthood screening should be mandatory before procreating! It's like a treat in our NICU when the parents are married, employed, and insured!

For PIV's - we use a saline lock. We switched a few years ago from all heplocks. There are lots of studies out that show there is no difference in how long PIV's last whether you use a hep or saline lock. So best to go with saline to avoid heparin errors. For central lines (our Broviacs or UVC's) - we use a 1 unit/10 cc hep saline flush. Our PICC lumens are too small to lock so they are dc'd as soon as the baby is on full feeds, off antibiotics, etc.

There is no difference in starting pay between units in the hospital where I work either...although we NICU nurses certainly wouldn't mind if there was:)