Questions about Pain

[juliachloe]

I'm hoping to find out about different avenues for pain control in other NICU's. Trying to help better our pain control in our unit & was asked to find out what other units do. We use the NPASS here & compared to another place I've worked it's ok. What pain scales do you use?

Does your unit give pain & sedation medication just for being intubated? If so how are your numbers on IVH down? Do they have bad withdrawal from the narcotics or are they weaned?

Do you give sucrose for all invasive procedures (IV starts, blood draws, heel sticks)?

What do your neo's give for chest tube insertion and maintenance? What do your post-op kids get for pain & for how long?

What about ibuprofen, are there rare cases when you utilize it for pain?

Your input is very appreciated.

[Imafloat, BSN, RN]

We have our own neonatal comfort score that a multi disciplinary commitee at my facility came up with. There are 5-6 parameters you assess and give a number value to each. If an infant scores greater than 3 we have to do an intervention and reassess in 30 minutes. We can do things such as give a pacifier, reposition, diaper change, prn med, scheduled med, hold, bundle. If an infant has surgery or orhwe invasive procedure we have to do a comfort assessment every 4 hours for the first 72 hours. On feeder/growers we do a comfort score at the beginning of each shift and no more unless they score above a 3. I normally do a comfort score with every assessment.

We usually use sweet ease with lab draws unless the baby is npo.

[LilPeanut, MSN, RN, NP]

We also use NPASS, we just switched a few months ago and people are still getting used to it.

Typically try and use sucrose for sticks, unless they are NPO (which is a lot of times) Morphine or fentanyl for chest tubes/silo reductions. ECMO kids are usually on a couple of pain control drips (versed, morphine, valium etc) and if they are post op, they have scheduled or PRN morphine/fentanyl (depending on whether they are intubated).

You have to do at least one NPASS per shift (I usually try and do at arrival and when I leave for stable/non-pained kids) and every hour for sedation and pain if they are on a drip.