gayle omansky

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

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.

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.

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.

Hi there, we have the same policy - the concept being to prove themselves before they move to postpartum unit where there is less surveillance.

Agreeing with Zuzana & Varady here.

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

I endorse the STABLE program also.

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

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.

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

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

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

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

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!

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.

Hi Mahatma, My facility has a subscription to Neofax on our portable computers. The last published books were in 2011, I believe. The program is easy to use - once you are in just start typing the name of the drug, it will jump to a selection on the list, when you choose it the info page comes up very similar to the book. it is also available as a paid for app for iPhones, I think it was $29/yr. from Truven Health Analytics. Support: http://www.micromedex.com/support/mobilerequest/ I can try to get the cost info for you for the facility wide program. Regards, Gayle

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

Hi knicole, What an accomplishment for a new grad - good for you! We are all aiming you at professional organizations & I have another one for you. The Academy of Neonatal Nurses' mission is education, & when you join you will have access to a large online archive of offerings. The next web presentation is in April on Abstinence babies & provides CEUs. Their journal is Neonatal Network & offers CEUs also. I would also suggest looking for a S.T.A.B.L.E course in the near future, it will give you a grounding in the steps of stabilization after resuscitation (stable.org). You were asking about blogs & I did find one - all things neonatal @winniepegneonatal.wordpress.com Best, Gayle

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

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.

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

Hi Adil, Thank you for responding to my question. It is interesting that your facility uses a less concentrated preparation of the medications. Can I ask you why you administer Ampicillin over 30 mins? Often it is given over 5 or 10 mins. Regards, Gayle

We start at 36.5c and then often adjust after a short time.

jriley - Med errors occur because we need to dilute meds & the draw the correct doses for neonates. There are few unit doses avail for this population because we are such a small part of the market. We have a standardized procedure for diluting meds listed on sheets in the unit. Double checks are always encouraged, but if a med is not on a standard procedure we absolutely perform a double check. We have minimal med errors. We rely on Pharmacy when we can, but sometimes we need to move faster. The traditional 5 Rs should be observed & I think we have gotten away from that. We do ourselves a disservice when we are multitasking or over-lulled into a routine when we are preparing meds. The Heparin errors were caused by not looking at the vial label closely. Do you have the ability to scan med labels? Scanning does verify that the correct med was taken from the storage system, but does not help with diluting at the bedside. Smart pumps? They are only as helpful as the info programed into them.