luvsnicu

Any facilities out there that use the delayed cord clamping method in their L&D unit? Just wondering how the NICU team feels about this and if it impedes care during resuscitation?

Wondering what other facilities use when it comes to drips or just multiple fluids. Our unit had always used double and triple lumen Y connectors for our babies on drips and such, but we've started to drift towards using just rows of stopcocks. It's easier to change drips this way and it certainly doesn't make as much of a tangled mess, but I'm wondering if it's truly best. We've seen a slight increase in our CLABSI rates in the last few years, as well, and I'm wondering if this could have anything to do with the use of stopcocks. They just seem like they would "hold" on to more bacteria and such in the crevices and connections. Thoughts?

With our tubing, we change TPN and clear fluids Q96. The TPN bag gets changed daily, but clear fluids can stay up for 96 hours, UNLESS they are changed by pharmacy. If they have adds, the bag needs to be changed daily. Lipid bags and tubing changed daily. Drip syringes and tubing daily. If fluids are mixed by pharmacy, tubing changed Q96 and bag changed daily. All bag and tubing changes are done at the bedside (why wouldn't you??) and clean, just with gloves. Our infection rates are pretty low, too.

We absolutely do not do routine suctioning on any baby of any gestation. With a little micro, I only suction as a last resort (baby desatting and doesn't come up, bad gases, etc.). Too risky due to IVH, pulmonary hemmorhage, etc. Our facility uses both HFJV and HFOV. And yes, with Jet vents, you absolutely should put the vent in standby mode (the baby still gets conventional support, just not high-freq), suction quick, and then turn back on. If you don't put it in standby mode when suctioning, the vent can sense that its not able to give the ordered amt of pressure and will try to compensate, thereby increasing your risk of pneumo. At least, that's my understanding of the Jet. They are pretty complex machines, but work great!

We just measure and aspirate. No xray, ausculatation or pH checks. We used to auscultate, but told that it wasn't reliable. We will just check placement on the next xray, but would never get an xray JUST to check placement. And with how often babies pull them out - I can't believe hospitals still xrays every time! Especially when it seems like there are still a lot of hospitals who insert NG/OG's daily or even with each feed. Completely unnecessary procedures and tests if you ask me. If you put an NG/OG to the correctly measured depth and it went in the lung, you're going to know! You would certainly see the baby coughing or desatting, unless paralyzed/comatose. I would think auscultation could be somewhat useful, but even if the tube isn't quite to the stomach, I would think you're still going to hear air in the stomach when injected.

We cover our NVN and lipid bags and use amber tubing. We used to do it for all kiddos, but now just those born under 30-weeks. I guess there was some research to show that the light broke down some of the proteins or vitamins (something like that) and that it could increase risk of BPD.