Yes, another procedure thread from me. Can you tell I'm going out of my MIND being away from the NICU?
So "my" unit recently discontinued two practices that could be thought of as restraints. One was pinning down the IV armboards. They'd tape the limb to the armboard on either side of the joint and then safety pin the distal end of the armboard to the bed. Reasoning for this is fairly straightforward: people were tired of IVs occluding when the babies bent their arms. Apparently JCAHO felt this was a restraint.
The second was tying paci's on. I never saw this done as the practice had been DC'ed by the time I got to the unit, but as it was described to me, they'd tie two lengths of the tan stockinette to the paci and then (LOOSELY) tie them behind the babies' head. Parents were told never to do this at home, that we could do it (like prone sleeping) because all babes are on monitors. The story is that when social work visited a NICU grad after discharge, they found the mother was DUCT TAPING the paci to the baby's face, and a report was made to child services, and the mom told them that our unit was Tegaderming paci's on, and she learned it from us. So that had to stop.
What are y'all's thoughts on this? Was it bad practice? Is it wrong that these were banned? Do your units still use either of these practices?
Wow. Maybe they don't feel comfortable sending kids home still on NG feeds. We do that all the time - teach mom/dad to pass the tube, have them buy a pump and teach them how to use it. But that's just ridiculous. The kid is going to learn to eat EVENTUALLY, and I'm sure they'd appreciate having their own liver and not being septic when they do.
I've never sent a baby home on gavage feedings before and wouldn't be crazy about the idea, but I see no reason why they shouldn't be gavaging in the hospital while they work up the energy to bottle all their feeds.
I've never sent a baby home on gavage feedings before and wouldn't be crazy about the idea, but I see no reason why they shouldn't be gavaging in the hospital while they work up the energy to bottle all their feeds.
Because nosocomial infections can kill.A year ago I thought the same thing, but we have been sending home more and more kids on NG feeds.It's a much more relaxed, attentive and clean enviroment at home.
We were the first NICU in Illinois to send babies home with NG tubes. We have our own home care program - half a dozen of our own NICU nurses work part time on the unit and part time in home care. They do visits and communicate with the pediatrician once the baby goes home. Any baby going home on oxygen, NG feeds, or monitors gets at least a few home care visits. They are discharged from our home care program when they either turn 1 year old and go to the pediatric home care team, or when they are able to get off the oxygen, NG feeds, or monitors.
We don't have the parents use pumps though unless the baby is on continuous feeds. If it's just bolus feeds, they hang them to gravity. (We don't use pumps for bolus feeds on the unit, either.) We always ask the parents if they are interested in doing this at home, and go from there. 9 times out of 10, they pass the tube, take the baby home, and say that it was a lot easier than they'd thought and they're so happy they did it.
Our own personal numbers have shown that these kids actually become PO AD LIB faster at home, and are more successful, than if they'd stayed on the unit. Pretty cool. Also have very few readmits related to feeding - when we get a kid back, or a kid goes to Peds, it's usually because their BPD is acting up and they need a boost of steroids, or that they're very anemic and having bradys at home.
What a neat idea with the home care being based out of the unit. I bet that really help with continuity of care!
We also send kids home on ng/og feeds occassionally, but usually they are nipplig to some degree. They run it over a pump for 30 min. For some kids it is run continous at night and q3 during the day, but that is for kids who are not nioppling due to lack of coordination (IVH) and wont be for quite a while.
We use the safety pins on the arm boards when they have a peripheral arterial line. We very rarely have PIV's (thankfully) because the docs are is quick to get PICC order in when the UVC is being removed. Of course piv when giving blood is a must unless we have a broviac, which isnt too often.
You betcha!How many liver transplant do you guys do a year?
Oh, this isn't a hospital that I work at. I'd last about 10 minutes there before being fired. They do a lot of other wierd things too.
It's interesting that so many are sending kids home on gavage feedings. My current hospital is the only one that I would see a real advantage to that because they aren't great at getting babies to eat quickly. My last place was really good about nippling to the point that they would even place challenging nipplers on 2 baby assignments rather than placing them on 3 baby assignments so that we had enough time to work with them. They were also a lot better at giving the nurses leeway rather than requiring us to follow their exact feeding orders and they actually listened to us when we told them a baby was refluxing rather than ignoring us and letting a baby keep refluxing for weeks until they had a terrible oral aversion (sorry to complain, that was my patient last week).
They had their kids on TPN/IVFs until they were able to nipple all their feeds. Crazy huh?
What is their incidence of NEC when they do start feedings? I have been taught that the earlier the feedings start the better it is for the intestines, especially if it is breast milk. The longer you wait the harder it is for the intestines to tolerate the feedings.
You betcha!How many liver transplant do you guys do a year?
elizabells, BSN, RN
2,094 Posts
Wow. Maybe they don't feel comfortable sending kids home still on NG feeds. We do that all the time - teach mom/dad to pass the tube, have them buy a pump and teach them how to use it. But that's just ridiculous. The kid is going to learn to eat EVENTUALLY, and I'm sure they'd appreciate having their own liver and not being septic when they do.