Sweeper933

Auscultation / aspiration upon insertion, and before each feed/med. X-Ray only if it's an NJ/ND. We also chart with each VS what cm the tube is at at the nares / lips.

I also agree with the previous posters. Sometimes the first sign that the line is going bad is that the waveform stops "behaving".

We also double check the label with another RN. We bring the second RN to the baby's bedside, and check the breast milk label against the bedside card, using name and dob. We add the patient ID if it's twins, just to make sure. "Word on the street" is that we will soon be scanning breast milk, just like we do our meds.

We will use a 5fr feeding tube as a catheter on our babies. Works pretty well. But we have to make sure to use the old style ones - the ones that connect to both feeding tubes and IV syringes, not our new orange feeding syringe only ones. This way, we just connect the end of the feeding tube up to the rest of a normal foley set-up.

How do you deal with skin integrity and all of that stuff on kids with long term IVs...??? I can't imagine having to put a bag on a kid for more than a few times in a row, let along days / weeks!!!

http://www.amazon.com/Certification-Review-Neonatal-Intensive-Nursing/dp/1416036679/ref=sr_1_1?ie=UTF8&s=books&qid=1252801839&sr=1-1 That's the book we all used on my unit. Although, a bunch of us have been taking a review class that has been offered in the area. It was 3 days, 8 hours each. The instructor was awesome - had powerpoint presentations for each of the topics, and had it all narrowed down to what was important to know for the test. Most of us ended up using that book as more of a reference as we were studying off of the notes from the class, as the book has a lot of information that simply isn't needed for the test. Good luck - just remember that you can't learn everything in the NICU right away! You need at least 2 years of clinical experience in the NICU to even take the test (if I remember correctly...)

Evidently the fun on my unit is continuing. I just got a call from one of the managers to see if I could come in to work tonight at 11pm. Evidently in the last 18 or so hours, they've gotten 35 wk twins, 27wk triplets, a kid with skeletal anomolies / hypoplastic lungs... and a giant omphalocele. Yikes...

This whole week we've gotten nothing but sick term kids. Which is always a nice surprise addition to the census. At least with the preterms, you have somewhat of a warning as to their admission. And all of these term kids have been really sick. A few bad mec aspirates, an unknown cardiac / other anomolies, and an unknown diaphragmatic hernia (that was fun....)

We (finally) slowed back down to normal after being crazy/busy all year. Our census is back to normal, but our acuity is still really high. A few really sick kids and a few really time-intensive chronics do wonders for staffing...

We weigh the diapers if they are on IV fluids, on oxygen, under phototherapy, or on diuretics. Otherwise we just do diaper checks.

We have several social workers that just deal with our Moms / families. If Mom is inpatient on antepartum, then they get hooked up with them at that point as well.

Even when it's an "off" time (non feeding or vitals) we still chart a lot of stuff each hour - bed temps, hr, resp rate, O2, IV status.... And for the first hour of our shift, we always chart their position, color, and their behavior (awake, sleeping...). That way if we come in at 7, but they aren't vitaled until 10, we still have proof that we've looked at them when we walk in the door

The wafer is the donut shaped piece of duoderm that gets cut out to go between the skin and the bag. It gives the bag something better than just skin to stick on to. It also helps protect the skin surrounding the ostomy. As far as the paste goes - I have no idea what you would have available over in the UK... The stoma nurse should know what it is if you do have something you can use.

Have you tried using stoma paste? It's used to fill in the gaps between the wafer and the bag. Works well when you have a tight area to work in and it's hard to get a good seal between the wafer and the bag all the way around. In my unit, when the stoma's start prolapsing as bad as you have described, we to take them to surgery quicker than we otherwise would have, so they can be reanistamosed.

All this math talk makes me really glad that we have our own NICU nutritionist with us during rounds every day! They are the ones who keep watchful eyes on all of the kcal/kg/day according to the growth charts and total fluid needs / restrictions and all of that. Of course we all use math when double checking med doses. Thankfully we have standard concentrations for doPa/doButa/fent drips, so the calculations are much easier for us to double check. For example, our fent comes in either 10mcg/ml or 20mcg/ml - depending on how slow it ends up running...