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...

And it continues... 35 4/7 twin girls, born right at 2000 when I walk in the door. I get twin B - who is a champ. Sugars a fine, temps are great, eating 15-20cc q3h PO, planning on sending her up to newborn after rounds in the morning. Twin A was the one with the slight temp issues and needed D10 for some sugar issues. I come back the next night and see that twin B was no longer in my assignment, I figured she had indeed gone up to newborn. I asked the resident who was standing right there when she went upstairs. He then told me that she had spontaneously perfed and was in the OR that very minute. I think my jaw actually hit the floor! Seriously!!! At 09 she was still fine. Girth was still 29, and ate her 20ml no problem. At 12, her belly was huge - girth up to 34... X-ray showed a huge amount of free air. Never had any temp issues or A/Bs or any of that other stuff. She had perfed in her sigmoid colon - only took out a few cm of bowel, and no ostomy or any of that non-sense. Since when do 35 4/7 wk babies spontaneously perf at 14 hours of life???

Well we never make q4 vitals due at 7-11-3... because then it would always be due during shift change - no matter if it were a 8 or 12 (or 4) hour shift. Because of this - vitals are never more than 3 hours after you walk in the door (start shift at 7, first set of vitals are at 10). Obviously, if it appears that something is clinically changing with the baby, we don't wait until that 4 hour mark - assessing immediately. On the "off hours", we are still doing hands off assessments on all of our babies - no matter what their vital sign schedule is. This includes taking numbers from the monitor (and actually counting respirations if they're on O2), assessing IV sites, fluid totals, oxygen settings, and a few other random things that are a case by case situation (iNO, chest tube site assessments...)

Most of our babies get hands on vitals every 6 hours. Either 8-2, 9-, or 10-4 depending on what their q3 eating schedule is. When they're unstable (on HFOV), they get hands on vitals every 4 hours. Once they're close to going home and eating every 4 hours, we do hands on vitals every 8 hours. Otherwise, we take numbers from the monitor every hour. If they're on any type of oxygen, we have to count their respirations every hour, and not just rely on what the monitor says. A few of our chronics will end up only getting vitals q12 h - depending on what their schedule is and what they have going on. This way, they can sleep all night and not get bothered too much.

We (finally!!!) have the Philips monitors. Touch screen functions are nice. As previous poster mentioned, it can be a process to view more than one baby at a time on a monitor. However - the layout of our unit makes it so we can see all of the babies in our assignment at one time. As we are still installing them (room by room), we haven't gotten the integration part up and running yet. We use EPIC for charting - anybody have experience with the Philips monitors and EPIC?

We do footprints at admission / as soon as the baby is stable enough / has no IVs on their foot. As far as getting the ink off - we have found that the hospital lotion works extremely well! Just put a big glob of the lotion on a diaper cloth and the ink comes right off of their feet!

I can't imagine not having windows!! Anyway - I like the design of our unit. We have 7 big rooms, each being able to hold 4-9 babies. Your assignment is always all in the same room, so you can see your babies at all times. Sometimes the rooms do get a little noisy with oscillators and alarms, but usually not too bad. A lot of us on my unit agree that we wouldn't like having single patient rooms - too hard to see what's really going on with your babies. Because we have our assignment all in one room, we do end up moving some babies around to accommodate for admissions / discharges / sick babies. We keep a list of what baby has moved where so that we try not to move the same baby too often. We explain to the parents that their baby might move a few times during their stay - that all the rooms are the same - and that it's so that their baby (and all of the other babies) can receive the best care possible - and that their primary nurses will still take care of them. They're usually pretty understanding of it all. We do have several pumping rooms and parent rooms. Parents can sign up for these. The parent rooms all have fold out couches for spending the night when their baby is close to going home. Hope this helps!

We also only treat when they're symptomatic. If they're able to get Indocin, they get that, along with fluid restriction (usually at 80/kg/d). If not / if Indocin doesn't work, we'll ligate if they're still symptomatic.

Twins (boy and girl) named Jack and Jill. Every time we say their names we all start hearing the rest of the nursery rhyme ...

One of our chronics just had a VP shunt put in. The anesthesiologist who did the case wasn't one of our normal ones - it was quite evident that he wasn't too familiar with premies. Anyway - the surgery goes fine (the baby was already intubated before the surgery). On the way back up to the unit, the anesthesiologist states that the baby should be waking up fairly soon, and should be able to extubate shortly after that. Well - what the anesthesiologist failed to recognize was that this baby has been intubated since birth (over 4 months ago...) at 27 weeks. He has horrible chronic lung disease and will most likely end up with a trach... It was just really funny seeing him have total lack of understanding of the history of his patient... the other nurses / docs and I all had a good laugh about this one! This also reminded me of the time the neurosurgeons walked through the fire doors that very clearly state "NO EXIT - ALARM WILL SOUND"...that was a fun and loud way to end the night shift!

We just take down one of our code / delivery bags. It has all the essential supplies, including code meds. We have most things separated by usage into plastic bags within the different compartments of the code bags. These plastic bags will contain all the necessary components for surfactant administration, intubation, IV insertion, suctioning, central line placement...... This way you can find all the necessary supplies for an emergent situation quickly with out having to dig all over the bag for various supplies. While the OR always has emergency supplies on hand, they often don't have the neonatal specific stuff within reach. Since we have a total of 4 of these bags that get used for deliveries / OR use, they get checked each shift by the charge nurse to make sure that all supplies that are supposed to be in there, really are. Sometimes right after a crazy delivery the charge nurse doesn't have time / forgets to restock what she took out of the bag... so by checking it a few times a day (and recording that you did so), they're (almost always) fully stocked and ready to go. Every 3 months on our unit, these bags, our crash carts, and our general supply room gets inventoried for expiration dates.