PremieOne

My NICU and several others in my area are having problems trying to find a car seat company that produces car seats that will hold premies that weigh

I have been asked by my fellow staff if any NICUs that use dual UVC catheters - clamp off one line if not needed. I have not been able to find any literature that will support this as a safe practice. We have several premies that are on restricted fluid intake and have poor peripheral IV access. Our Neo docs want to clamp off one of the dual lines so they do not have to use 2 TPN IV bags. If any NICU does clamp off one line do you have a policy for this and would you provide the literature that will support it. Thanks PremieOne

My NICU is having a major problem with car seats. We are sending premies home that are less than 4 pounds (small for gestational age). The one car seat that did accommodate these tiny infants had a recall and we no longer use them. The car beds on the market say 5 pounds or greater and so far we have not been able to find a company that has a safe car bed or car seat that has one for premies less than 4 pounds. Does anyone know of a car seat - car bed company that accommodates these tiny infants.? Do any other NICUs have a similar problem? The insurance companies are refusing to continue hospital coverage of these infants and the hospital does not want to pay for another week or two until the infant reaches 4 or 5 pounds. Diane Glasser MSN, RNC

Dear Steve, Thank you for sharing this video web site. Many of us as NICU nurses rarely see how parents deal with situations like this. I thought the parents did a beautiful job of presenting a tragedy in a positive light. As a nursing instructor, :redbeathethis is a wonderful video to show student nurses and to NICU staff. PremieOne MSN, RNC

I am wondering how this could happen!! Normally your oxyhood has oxygen or air going through humidity and so the gas is humidified. We all know how wet the oxyhood gets along with the blankets and clothing surrounding the infant. I have been a nurse for 42 years and have never seen or heard of this ever happening before. When we first used oxyhoods they were not always humidified, but we did have times where we had static electricity problems when touching the warmer. That stopped when we started wearing metal strips on the backs of our shoes. I think we should try to figure out what caused it so it will never happen again. PremieOne

I am an advocate for breast feeding but this idea of nipple confusion is all wrong. I have been a nurse for 40 years and have never seen any infant with nipple confusion. There were many moms who were being pushed into breastfeeding either by the staff or family when the mom did not want to breast feed. I think it is terribly wrong to force an infant to cup feed or syringe feed just because the mom or family member feels the infant will develop nipple confusion. I have had many heated discussions with our lactation specialist on this issue. Forcing an infant to feed this way is not helping the infant learn how to suck properly. We have had OT specialist trained in feeding disorders agree that this is an improper way of feeding a newborn. As several other members have stated that if the infant is allowed to be hydrated with use of bottle feeding, the infant will gladly return to breast feeding because she/he feels better. We have moms continue to breast feed and then give supplement and have moms pump q3h when not able to be with infant. Moms are much happier when she takes infant home healthy. We are now trying to get banned any syringe or cup feeding in the NICU. We all feel it is a dangerous idea and puts extra stress on an already compromised infant.

We have a separate med system that has either NSS or 1/2NSS in a bag. We have a special flush system where you place your med syringe on the syringe pumpand infuse through tubing that is piggybacked to TPN or what ever IV solution you are running. We change this system q 72hrs. No infections so far. If med not compatable with TPN/or lipids they are turned off till med is in.

Thank you for providing this news link. I think we are going to see more incidents like yhis in the future. We just got back an infant from a tertiary children's hospital collonized with MRSA. The infant is in our isolation room till discharge. The ifant shows no signs of illness but is now considered a carrier. As for our laryngoscope blades - we soak them in an atibaterial solution for 30 min and wipe the handle down the same solution. We so far have not had any infections from this practice. But maybe we need to revisit our policy and procedure manual and update it on the way we sterilize this equipment. Nosocomial infections are running rampart in many hospitals. As this article states and those who have already provided feedback on this article - many places try to cut corners to save time and money at the expense of the lives of the public and patient. Thanks again for the article link. Happy Holidays

SteveRN21, I would be very interested in your protocol. We do keep our infant's midline for about 72 hours and if they are stable we will place them on their abdomen. We provide nesting to all our infant's no matter what size or GA. We use snugglies and artificial sheepskin to protect them.

BittyBabyGrower, You are correct on the alarms sounding if the prongs are out. They can also be anoying if your infant is on PSVG and the limited PIP is set too low. The alarm keeps ring low VT and that is when you want to strangle the doc or the machine. Good Luck on your trial. We were trying to talk our neo docs into using nitric but they said if the infant failed it it would take too long to transport the infant to a tertiary center that has ECMO. They consider our unit too small for this.:smilecoffeecup:

We change TPN and Lipids q24h as suggested by CDC. Our UAC lines get changed every 72 hours.

We just started using Ibuprofen to treat our micropremie's PDAs. Is any NICU using this drug and do you have a protocol you could share with me? I have seen the huge problems using Indocin and hope this really will decrease the major side affects seen in using Indocin. If we are unable to close the ductus we send for the "Duct Busters" fron CHOP. They arrive and in 45 minutes have completed the PDA ligation right at the bedside. The only changes in the unit are that no visitors are allowed in and all staff wear hats and masks while the surgery is done. So far none of our infants have gotten an infection.

My unit has been using Dragers for several years. We love them because they are quiet and have several settings for both vented (SIMV, PSVG, etc), and CPAP infants. Infants can be on CPAP and a back-up rate can be dialed in for that reminder to breath. We use it for those micro-premies that we are trialing to remain off intubation. One of our neo docs feels there is a "window of opportunity" to catch these infants in their breathing mode and eliminate the need for intubation. If any of you are familiar with Dr. Wang at Columbia/Presp. Hospital in New York City, he believes in this idea and is using CPAP and nitric oxide on all premies. He has used back-up rates too.

We are seeing major hypertension in the infants we have on Methadone. From what I am hearing from other NICUs it is taking a much longer time to wean these infants off Methadone. Our Neo Docs refuse to go back to Morphine solution because they need to give it q3-4h and with Methadone you only give it daily or BID. Does anyone have a list of side affects for methadone use on withdrawing infants?

My unit recently switiched from using oral Morphine solution for withdrawing infants [whose mother during pregnancy had been on Methadone maiteance], to Methadone oral solution that is given daily or BID. Is any NICU using Methadone for NAS infants and do you have a policy on it you would be willing to share, and do you have any references on evidence based research on the use of Methadone in infants? We are giving this medication and can find no information on its use, and need parent teaching information for discharge home so parents are aware of side effects and complications. Thanks for any imput.

Dear Saah, Yes it does. You can go for your certificate. Many programs now allow you to do most of your study online. The clinical hours required can vary greatly. This is the actual hands on care you give. You can obtain this in your own area where you live or go to the university that is providing the course. I am going to Seton Hall and I will be doing both. Good Luck. Diane Glasser

I was born & raised in NYS and I worked at St. Luke's/ Roosevelt for 10 years in Peds and Ped ER. I also worked at Memorial Sloan-Kettering in Peds.I would go for the Columbia University NNP. Do you have your Masters already? I did both my BSN and MSN online. I had to do clinicals and it was my responsibility to find NPs or MDs willing to precept me. It was tough but it was worth it. Believe me you are not allowed to slack off doing online classwork. In many ways it is more challenging. I think in this case regular classroom is better for you. Good Luck.

You need to work with vents all the time in order to maintain your skills. My unit cares for 22 weekers and above and we can have 2 or 3 oscillators plus conventional vents going. I agree with Jolie who stated, "Send each and every staff nurse to a Level III NICU for vent training. This needs to be AT LEAST a week in length, during which you would receive both classroom and clinical training (1:1) with a preceptor doing hands-on care of vented babies of all types (preemies, surfactant administration, full-term meconium and pneumonia babies, whose care differs greatly from that of preemies)". Good Luck.

Our unit sends the nurses to the Hershey NICU course or some take the online NICU course from University of Indiana. Also use and read the core Neonatal NICU text and also "Workbook in Practical Neonatology". Good Luck on getting your NCC.

Starting IVs can be frustrating at times. It takes practice, skill, luck, a good IV catheter product (we are trialing 3 new types) and whether you can visulize the vein without transluminating. With some of the new types of IV catheters you do not get a good flashback and so you have a 50/50 change of getting the IV. One thing to remember is securing the IV after insertion is very important. We use bio-oclusive to cover the IV, double back the tape, and place an armboard on the extremity we have IV in. We do not like doing scalp IVs. We usually go for PICC lines for the infants who keep losing their IV or have MEDs fo more than 5 days.

NICU_Nurse you are in luck, I still have the package the flat light came in. I got it at target. It is from Energizer Trim Flex LED. It cost less than $10 before tax. I hope this helps. It works great as a transluminator in starting IVs and doing art sticks. We do all our own IVs and blood draws.

My unit is small only 24 beds but it can be hectic at times. In the NICU area it can be 1:1 for sick premie or unstable newborn/or micropremie that has lines and is on oscillator. Also post-op infants that have had "Duct Busters" from CHOP to ligate PDA, laser eye surgery that were on vents, and those with neurosurgery. It is 2:1 for vented infants or 1 vented and 1 CPAP or HFNC. If we are short the ANM will pitch in and help. In PCU with the feeders and growers - may be on HFNC, or NC it is 3:1 or 4:1. Infants in isolation and NAS infants are cared for by staff in PCU land. The unit is all RNs with one PCA that occationally will help po feed infants.

My unit uses snugglies from Children's Medical Venture (Products, Childrens Medical Ventures (CHMV), Respironics ). You can get their developmental positioning packs. Everything can be washed and reused. As for isolette covers, we have a hospital auxillary made up of retired staff who make the covers for us. They cover the plexiglass part of the isolette. It covers all sides and has slits with ties or velcrove for the side port holes. The front and back can be lifted up separately to observe or care for the infant. It is made of neutral color of off white and is quilted on the top layer and smooth on the bottom layer that faces the infant. This protects the premie's eyes from the bright light, reduces the noise level and provides extra warmth if the unit is cool. I hope this helps. PremieOne

My unit is a Level II/III in which we do some sugeries. We have an ANN on evening & night shifts who is in charge of the unit. She usually does not take an assignment but is there to help out if we get multiples back to back. She also helps out with dinner relief. PremieOne;)

I also went out and bought an inexpensive "cold light" LED flat flashlights that come with red, blue, or white lights. They do not get hot and work so much better than the $100 one's our unit purchased. The one I just got from Target is flat and flexable and is small enough to use on micro premies