Rough Night in NICU

[navynurse06]

So I usually work on the regular in pt peds ward, but we are often floated to the NICU because they have staffing issues to say the least. But that's a whole other thread for another board.

Any how....I was floated to the NICU. I was assinged two babies, while I'm getting report on my 1st baby she begins to desat so the day shift nurse repositions her, suction, CPT, but no improvement. So we provide blow by and get the DRs. In the middle of this the day shift nurse for my other baby comes up to me and ask to give me report on my other baby. So I take it...go back my 1st baby. The charge nurse sees what's going on and ask me if I want a to give up my 2nd baby and just have this one or take 2 other babies. I wanted to focus on the one really sick one. I'm not scared by the situation...I used to work in and adult ICU so I've had a lot of experience with pt's trying to go to the light. But this is my 1st experience with a baby.

So I took the one baby. To give you some hx on this baby: She was 41 wk baby, born perfectly healthy. At 12 hol the baby arrested; mom was breastfeeding and talking on the phone at the same time. When she got off the phone (after 11 min) she noticed the baby was acting funny and discolored. So the nurse was called and took the baby out. The baby was blue; baby was coded. Not breathing; no heart beat. She was intubated and est. heart rate. She then was flown to our hosptial's NICU.

She remained intubated for a couple of days, was extubated then intubated again. Then extuabated again. So when I came on she was on room air.

The family had been educated on her condition, and her long term quality of life. She was without O2 for more than 10 mins so all of you know that she has major brain damage, and can't do anything on her own.

So back to my night....we continued bb and got a gas. CO2 was something crazy like 72! So dr's called the family to make sure they still wanted everything done, and they did at that time. So we applied NC and she maintained her o2 sat really well at that. Before we gave her he O's she had that "death rattle" while breathing. Also, she was still having alot of thick secretions and needed suctioning frequently.

The DR had another talk with the family about DNR order and letting the baby pass. A couple of hours latter they est. the DNR order, which included standard no cpr or intubation. It also included stopping the feedings, removing NJ tube, and no labs. We kept TPN/Lipids and o2 and added q4 morphine. And they were to remove the crm/po monitors later on on tuesday.

It was such an emotionally draining night. The family stayed at the bedside for several hrs before the order was written, then left not long after. Of course they were very upset...crying...etc. Before they had the DNR made both mom and dad wrote the baby letters and put them in the crib. That just broke my heart; i'm crying just thinking about it.

Its a young family. Dad's marine who was deployed when the baby was born, so he's never seen her healthy. He was flown back right after this happened. Everything about this breaks my heart. This is way different than dealing with adult pts whom are at the end. And this is why I want to go back to the ER or the adult ICU!

How do you experience NICU nurses deal with situations like this? And what do you say to the families?

Sorry for the long post...I just wanted to share with all of you.

[adrienurse, LPN]

(((Navy)))

[rn/writer, RN]

Scares the bejabbers out of me to read this post. I work postpartum and have been appalled at the way some of the patients take care (or rather, don't take care) of their babies. Just last week, I walked into a room and couldn't find the screaming newborn. Mom's in bed covered up to her neck. Crib is empty. No one else in the room. Finally, I trace the muffled crying to the bed. I ripped back the covers and there was the wee one half under the (large) mom.

Mom didn't awaken until I bumped her as I removed the crying child. Thank goodness, the baby had enough air to cry, but one false move by mom could have ended that.

Got everyone settled down (including my own racing pulse), strongly reiterated the importance of putting baby in crib, and left the room with mom feeding baby.

Came back later to find baby lying on bed next to mom with her talking on the phone. I moved the baby to the crib and didn't really care if mom was po'd.

At any rate, I am so sorry for everyone involved in this horrific tragedy. What a senseless loss. I'm glad the poor child had such compassionate care, and I'm really glad the parents had the ability to let the child go. I'm sure that was as heart-wrenching as it gets.

It sounds like you did what you could. As far as what you say to families, I think you just tell them that you're sorry for their loss and their pain and, if they care to talk, you'll be glad to listen. There really isn't anything else to say, especially in a case like this one where the mom is probably suffering tremendous guilt. I hope someone is going to help them get counseling.

Can you talk with the NICU nurses at your hospital? Seems like they would want to provide moral support for you, especially as it isn't your regular unit. Unfortunately, if you don't float back there for a while, there might not be an opportunity for you to receive this. Maybe you could stop in to talk and let your thoughts and questions be known.

I wish you the best. The family, too.

[traumaRUs, MSN, APRN]

Awww Navy Nurse - it sounds like you did wonderful. That baby and the family were lucky to have you. Like the ER, I would imagine the NICU has some type of support system in place for these tragic situations. It is important that you have someone to vent with and cry with. Thank you for being there.

[navynurse06]

To Trama...thank you for your kind words!

To rn/writer....I added the feeding and phone call part of the story to give a background. I'm not blaming this mom (only 20) for anything or judging her! She is going to be dealing with a great deal of guilt for the rest of her life. Not only did she have to make the choice to withdraw care from her baby but she may feel like the whole situation was her fault. My heart just aches for her.

And I almost postive that I'm going to get floated up there when I work again tonight!

[rn/writer, RN]

To Trama...thank you for your kind words!

To rn/writer....I added the feeding and phone call part of the story to give a background. I'm not blaming this mom (only 20) for anything or judging her! She is going to be dealing with a great deal of guilt for the rest of her life. Not only did she have to make the choice to withdraw care from her baby but she may feel like the whole situation was her fault. My heart just aches for her.

And I almost postive that I'm going to get floated up there when I work again tonight!

I didn't mean to imply that you blamed this poor mother. It just struck a chord with me because of my recent scare and because the mom I dealt with didn't seem to learn from her near miss.

You're right that she will probably struggle with guilt for the rest of her life. She never meant for anything bad to happen to her child. I hope this young couple's marriage can survive such a fierce blow.

If you get floated back to the NICU, please share your thoughts and let the regular staff give you some TLC.

Hugs to you.

[Spidey's mom, ADN, BSN, RN]

What a tough shift . . . .:icon_hug:

I'd be interested in any autopsy results . . . . we once had a baby born perfectly healthy and then deteriorated due to heart problems and pulmonary hypertension . . . .

steph

[RNin2007]

I'm really sorry, but wow these parents were lucky to have you as their baby's nurse. What a painful thing to have to go through...

~J

[navynurse06]

I just wanted to update everyone on this little baby. She passed away on Tuesday nite.

[Love_2_Learn]

This is the kind of sad situation which is very difficult for everyone to come to terms with; thankfully it doesn't happen very often.

It brings to my mind the wonderful organization www.nowilaymedowntosleep.org which this family would have been perfect candidtates. If you've never been to the web site, I very highly recommend it.

I remember a baby brought to our NICU coding from the mother-baby unit; he had simply "gone limp and turned blue" in Mom's arms. Turns out he had a heart defect which required his dutus arteriosus remain open; as soon as it closed (usually within the first 24-48 hours in normal term babies) the baby coded. We started prostaglandin infusion and the baby was successfully transferred to a larger hospital for cardiac surgery. It was many years ago, but if I remember correctly he did well. In his case the Mom was able to recognize the problem immediately so I'm sure this helped his case immensely.

Big Hug to you navynurse06 for taking such good care of this baby and family; it sounds like you truly did your best for them and to me that's one of the main purposes for being nurses...caring for the human condition.

:redbeathe

[km5v6r, EdD, RN]

:icon_hug: After 15 yrs working with adults and in adult ICU I now work in PICU. It is different to lose a little one. Even though you know in your head that withdrawal is the best choice your heart still fights the idea. With an adult the end may be painful for the family and seeing that pain can be hard for the nurse but there can also be a sense of completion. A sense that the circle somehow has been closed and the life completed. With a little one you are dealing with not only the loss and pain of the family but also the sense of betrayal and loss of the future or potential of that little one. The heart believes that all little ones are supposed to be born health, and grow up happy. Reality is that not all do. On some level there is also the realization/fear that this could happen to me. That adds another layer to the grief/emotions of the moment.

You did the right things in staying with the assignment and supporting the parents through their personal hell. It may sound strange, but go back to the NICU. Talk with the staff. They know the story and are probably reeling as much as you. They are someone to talk with who you don't have to relive every detail with. They may also have special supports services in place for these types of incidents.

I am not meaning to stir up trouble but I am suprised at your being given such an assignment as a float. This is the type of assignment that only the experienced staff in my unit would take. I am not meaning to imply you don't posses the necessary skills but the emotional toll for both you and the family was excessive. You have never been in the situation of a baby leaving. It is very different and an emotional burden you were not prepared for. When you accpet a position in NICU or PICU you KNOW you will lose little ones. You begin to try and prepare yourself for that fact psychologically. Before I every considered this move a thought long and hard about how I would deal with and even I could deal with the loss of little ones. When you got ready for work that night I'm sure it wasn't with the idea of "I'll float to NICU tonight and learn what it's like to make a baby a DNR." For the parents making these discisions without the support of someone familiar with them caring for their child it is also difficult. You are a good nurse who did an admirable job but to have a familiar shoulder to lean on and cry on may have been easier for the parents.

All in all you had a night passing through the flames. You have every reason to grieve, and feel the pain of the burns. I wish I had some magic words to help.:icon_hug:

[rn/writer, RN]

I'm sorry to hear this precious child's brief life has ended.

Will there be an autopsy to see if there was some kind of heart defect or other anomoly that caused the baby to arrest? Such a finding certainly won't take away the grief these young parents are facing, but it could relieve the mother of her guilt feelings.

Were you able to get some moral support and TLC from the NICU staff?

Many hugs,