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gayle omansky

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gayle omansky last won the day on April 25 2019

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    Newton-Wellesley Hospital
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    Newton, US

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  1. We use the AccuVein from time to time. It is not my favorite assist & I usually just use an overbed bright light. The light seem to actually blur the vein so it will appear slightly larger than it actually is, so it is best to approach straight on centered. If you are used to sliding in from the side of the vein you will likely miss. With the lights off & the red glow it is easy to miss the start of the flashback so you might go in too far too fast. I have taken to going very slow with an off/on, off/on of the overbed light. best, Gayle
  2. Hi! We do not find dried spots frequently but our “hard surface wipes” which are also 70% alcohol will clean them up at least to the naked eye. Nurses clean occupied bed spaces & housekeeping comes to thoroughly clean vacated spaces with different solutions.
  3. Peripheral line antibiotics are prepped by nurses at a med station. Central line meds are prepped under hood in pharmacy. Tubing changes are done at bedside on a sterile field.
  4. NICU= NRP, we do not switch gears. We do have tension with our Peds ED when we are called to assist with a newborn though, they follow PALS & we do not.
  5. We use a servo control temperature probe during resuscitation and upon admission- transport is to only time we do not have servo control available.
  6. Hi there, we have the same policy - the concept being to prove themselves before they move to postpartum unit where there is less surveillance.
  7. 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
  8. 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
  9. 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.
  10. 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
  11. 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
  12. 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
  13. 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
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