Hi, just had a babe the other night 25 weeks, new admit whose fingers turned blue along with a streak across her abdomen that followed a path into her forearm and to the armpit. I drew labs off the UAC multilple times had dopamine going in because my means were so low and wasn't getting the response that I should have, the UA was zerod a couple of times, good wave form and after the two boluses I gave it stayed the same. Got an order for 0.2 mcg of dopamine per hour, no titration order. Means stayed in the low 20's or high teens for over 3 hours. Babe was on vent and asymptomatic (hr/sats ok). By 6:30 am I drew my last gas as we had been weaning her rate several times during the noc and I came back to add in my scheduled amp to the UVC and noticed the blue streaking and blue hand/fingers. Got an order to d/c the UA, and start a PIV for the dopamine. I immediately put the warm washcloth on the other extremity and got the doc. Within 15-20 minutes the streaking across the chest and arm were gone (doc said the bruising was there since delivery --- not so, babe was mine all noc) and before I left 1 hour after my shift was up, trying to get everything documented, the fingertips were still blue. I was taught to watch for flank, buttock, feet but I have never seen it happen to an upper extremity. I am new, this was my first noc with a UA and UVC, the babe was about 8 hours old when I got her, lines were measured at every check during her assessments, i had multiple lab draws, had someone else watch me as I had done it for the first time a month ago and performed it correctly. I also had a nippler going home who took 25 mins to nipple but was right next to this babe. Babe was still on open radiant warmer so I am sure that I was on top of any changes. Ironically the doc rounded on the babe and it wasn't five minutes when I went back to him and showed him my findings. The only thing different that I did between sending my gas was starting my amp in the UVC, and repositioning her hips slightly to the left (head was turned left) babe technically still on back due to lines. Can any of you explain why this happens? I am still new so of course someone told me that one time a kid lost his fingers, etc.... They say that it can happen quickly. I never sat down all night and know that it was a new finding with those minutes that I mentioned. I watch my babies more than some of the experienced RNs and things like this seem to happen to me. Fluids were at 3.3 and 1.0 (with the heparin) plus the dopamine at 0.2 if that makes any difference. The amp I gave was over 15 minutes with a 0.5 cc flush over 10 mins. Thanks for any help with the patho.
Oh, we do, all the time. We try to get them in a humidified isolette asap, but if they are transported over for either PDA or NEC surgery, they are placed on a warming table for a few days.
Yes they stay in the radiant warmer for awhile depending upon how critical they are. About 24 hours. One I had the other night I put in an isolette during my shift about 12 hours after admission. They have to have lines put in and the surgicals stay about 24 hours on the radiant bed too. We only have a few giraffe isolettes so the old ones can't be opened up from the top to put lines in.
MegNeoNurse
241 Posts
This is off topic from your UA/UV question, but, your unit puts 25wkrs in radiant warmers!?