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gayle omansky

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gayle omansky last won the day on December 21 2016

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About gayle omansky

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    Newton-Wellesley Hospital
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    Newton, US
  1. When parents are rude in the NICU

    Wangyang, we find anger & rudeness occasionally, it is helpful to think of it as stress reaction behavior & a possible indication of PP depression in either or both parents. We are considering giving out the Acute Stress Disorder self scale along w/ other info on self care etc to our parents in hopes that it will help them reflect on their situation & find ways to help themselves.
  2. sibling visitation policies?

    During "non flu season" we have 24hr open family visiting. We have parents fill out a "sibling visiting" form attesting that the siblings have been fever, cough, congestion & rash free for the past 48hrs. The parents fill out the form once & we expect that they will not bring in children if the situation changes. No other children under 18 yrs allowed. We do have issues around the children not being monitored or contained by parents. We also have a nearby visiting room with a few toys that parents can trade off visiting the baby & containing the siblings. "Flu season" as announced by the state department of public health - likely 11/1-5/1 closes visiting to siblings. we have had a few (over many years), contained (2 babies at a time) RSV outbreaks. We have recently had to move babies into our isolation room for viral respiratory symptoms & put on droplet/ contact precautions. These babies all had ill family members. rigorous hand washing policy & constant hand gelling as modeled by staff helps, but it is a difficult balance between being family friendly & protecting our babies. We encourage FaceTime & have 2 iPads on the unit for this purpose as a visiting substitute. Best, Gayle
  3. neonatal transfer

    I endorse the STABLE program also.
  4. Hi Aymen, I agree with Tarek above - both the Neonatal Resuscitation Program & the STABLE program are invaluable. Physicians, nurses, midwives & respiratory therapists all take NRP at my facility and I have taught nurses, respiratory therapists and emergency room nurses the STABLE course. STABLE is the stabilization of infants after resuscitation, so they go hand in hand. I teach both, so I am biased... The STABLE course is endorsed by the AAP & the March of Dimes & has been translated into a good handful of languages. The AAP also has a self learning perinatal-neonatal course in their catalogue which is six books. PCEP specialized newborn care - shop AAP www.stableprogram.org best, gayle
  5. Daily Care of Umbilical Catheter

    Stefan, Good point, we use the Tegaderm for all our babies > 27-28 weeks. We still use bridges for under that age. We use a premade product called umbilical catheter anchor, which is foam & adhesive. Because it is very adhesive we trim down the "legs" that go on the baby's abdomen & use thin strips of the Duo Derm under the legs. It is all watched carefully because of fungal infection issues under the Duo Derm & skin damage when removing.
  6. Daily Care of Umbilical Catheter

    Stefan, Here are a couple of pics using our SimBaby illustrating securing a catheter down to the abdomen. We also suture first (not in pic), & decided on 2 loops because we had traditionally secured 2 loops into our bridge. It seems to work best to have the tail coming out the bottom to the side. This keeps the catheter away from fingers & legs. We also try to catch as much of the catheter at the umbi as possible for safety. If both UA & UVCs we use a bigger op-site looping each a little to the side. Some folks use a skin protectant product such as Duo Derm in addition. The caution with this method is that the Duo Derm holds moisture against the skin which is exaggerated when covered by the op-site, & this has revealed problems when removed. We find the op-site adheres well as long as it is put onto dry skin. It has not caused damage when removed as long as we use the "stretching to break the adhesive" method. I hope this is clear enough. I can get over to the Sim Lab this week for more pics if need be & apologize for the missing cap in the line set up. Best, Gayle
  7. Daily Care of Umbilical Catheter

    Stefan, Sure thing, I will look for photos for you. We moved from bridges such as yours to the op-site/ Tegaderm method a while ago. We feel it is very safe & allows for more confident handling/ holding by parents because the securing does not get caught in blankets. i will get back to you soon, gayle
  8. 1st 99nicu Meetup, 12-15 June 2017

    Hi Stephan & Francesco, here are some thoughts & ideas for nurses / nursing subjects for your conference. Madge Buus-Frank DNP NNP director of quality improvement & education for the Vermont Oxford Network gretchen Lawhon PhD / developmental care & NIDCAP Karen D'Apolito PhD Vanderbilt Univ / neonatal abstinence Sue Ludington PhD Case Western Rererve Univ / reducing stress in the NICU neonate Jeanette Zaichkin NNP / neonatal resuscitation program Kristine Karlsen PhD NNP / founder of STABLE - the post resuscitation stabilization education program Mary Coughlin NNP / trauma informed care in the NICU And now Occupational Therapists: Sue Ludwig OT / founder of the Infant Driven Feeding program & president of the National Assoc of Neonatal Therapists Robin Glass OT/ LC Seattle Children's Hospital / one of the developers of the NIFTY cup a low cost feeding cup for infants w/ special needs Regards, Gayle
  9. Daily Care of Umbilical Catheter

    Hi Aymen, We do not cover the umbi site. I have checked w/ a few others who have experience in other parts of the country & they agree that the practice is to not cover. This allows for monitoring of site & insertion depth. Our practice is to secure down loops of the catheter onto the abdomen w/ Tegaderm (op-site). After prepping the skin & then washing off the prep w/ sterile saline, you will be securing & covering the extra catheter onto very clean skin. No daily care is needed. We cut a small half circle out of the Tegaderm to allow it to sit very close to to the umbi without going over the site. Regards, Gayle
  10. Heparin Lock

    Hi Stephan, We still add Heparin to all our central line infusions at 0.5u/ml. This is a very interesting discussion & we may need to reconsider our practice. Thanks!
  11. Heparin Lock

    We also run our central venous caths at min of 1ml/hr. We recently locked one side of a double lumen venous cath (as a physician preference), & found that it clotted even with regular flushes.
  12. How do you measure blood glucose?

    We find good correlation between bedside glucose values w/ Accu-Chek Inform II by Roche Diagnostics and serum glucose values from chemistry microtainer tubes that we send to the lab. Regards, Gayle
  13. Management of Term SGA

    Hi Marcello, If an infant is below 10th % we routinely test for CMV & less routinely investigate for TORCH. Only occasionally ultrasound. We would always enhance nutrition. Regards, Gayle
  14. Hi Stefan, We use Fentanyl at a lower dose (0.5-2mcg/kg) given over min of 2 minutes combined w/ Midazolam 0.1mg/kg also given over min of 2 minutes. We have seen instances of chest wall rigidity, so we go low & slow. Alternately we use Morphine 0.1 mg/kg. Neofax is our med reference.
  15. please i need your help doctors!

    Hello, You may want to look at the resources via the American Academy of Pediatrics for some of your education needs. Along w/ Resuscitation, the STABLE program (stabilization of the ill newborn) & a multi-part Perinatal Continuing Education Program are under the AAP umbrella. Both programs are very good & would be valuable in community based care centers as well as tertiary care centers. Regards, Gayle