Sat monitoring -- Car Seat Test -- CHANGES?!

[spacey]

Hi --

There has recently been a HUGE push from the docs in our unit to d/c the sat probes on our babies shortly after they reach level 2 status. (assuming they are on room air) These orders are being written sometimes even for babies with mild A/B episodes. This is requiring a big adjustment period from the staff.

The latest change is to our car seat testing practices. We currently test any baby

[BittyBabyGrower, MSN, RN]

wow. Even our nursery uses a pulseox on the late pretermers. My question would be, has your hospital policy changed? If not, you need to comply with the policy until it is rewritten. What does you manager or CNS say about this?

[karnicurnc, MSN, APRN, CNS]

Wow, that sounds crazy! Recently the AAP recommended that corificeat studies be 2 hours long. I will post the reference. They may also say something about a pulseox. We use them for the study. In fact, it has to be documented every 15 mins.

[karnicurnc, MSN, APRN, CNS]

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;104/4/986

This link addresses a policy that states O2 sats should be monitored. See if that helps.

[Love_2_Learn]

I would think that the pulse oximetry probe would be necessary to help validate any heart rate drops. You know, when you correlate the two helps to be sure you are seeing what you think you are seeing...? We also do not discontinue pulse oximetry monitors until the baby is considered term and has not had a heart rate drop or oxygen desaturation for a full 7 days. We still do car seat challenge tests on all babies who were born at less than 37 weeks, are being discharge on nasal cannula or are especially small for their age. I like that our neo's are more cautious than some others are... Good luck!

[ittybabyRN, RN]

Our kids never loose the monitors...not until the discharge paperwork is in the parents hands

[heymama1plus1]

Their pulse ox is put back on for the car seat trial (if it's off).

[Elvish, BSN, DNP, RN, NP]

I'm in wellbaby (plus a little) nursery and we don't routinely keep our kids on any constant O2sat monitoring. However, for the corificeat test, we monitor the kiddo for however long he's in the seat. We do anyone under birthweight 2500g and anyone

[spacey]

Fantastic replies -- thank you all.

Yes, my unit manager is aware of these changes and currently our policy and our electronic charting are both oriented to sat monitoring during the observation. I believe the event that triggered this involved a nurse telling a parent that the baby had "failed" because of a desat (or 2?) and the parent being insulted that their baby had "failed" something...and also feeling like prior to the test, desats were excused as "the monitor just isn't picking up right" etc, but when it came to the car seat test it was treated as accurate and resulted in a "fail". Consequently, now nurses are no longer able to determine a "failed" test -- and in fact have been told to drop that pass / fail terminology completely.

We are in the process of re-writing the policy to cover us ... as you are right, we can't really make that a change if our policy doesn't reflect it. Our medical director indicated that the AAP had changed their position about sat monitoring, but I didn't follow up on that. Thanks for the link -- I will do more research before turning in the policy for final approval. If it turns out it has changed, I will be sure and update everyone!

thanks!

[littleneoRN]

Wow, now our culture of passing kids to make them feel good has reached to newborns (and their airways--yikes!). So, if a nurse can't determine that a baby has "failed" the test, or maybe in more positive language, "isn't ready to sit safely in a car seat," then what is the point of the test? I think we can educate parents that we can tell the difference between a pulse oximeter not picking up and a real desat. We would never do a car seat trial without a pulse oximeter. Babies can have brief self-resolved desaturations and still pass. The pulse oximeter is discontinued on many of those kids by the time they test, but of course it's put on for the test.