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JoannieO last won the day on May 27 2018

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About JoannieO

  • Birthday 08/27/1952

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    Registered Nurse
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    Waikato Hospital
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    Hamilton, New Zealand

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  1. The Sugar babies trial did indeed look at babies at risk of hypoglycemia, however, in our unit we have used dextrose gel as a first line treatment for hypoglycemia for many years. The Sugar babies trial and associated research provided us with the evidence that we needed to underpin this practice. We use the BD lancet for heelsticks and process the sample immediately - we are lucky enough to have a blood gas analyzer on our unit. Using dextrose gel as a first treatment, along with feeding, has meant that most babies can be managed without IV fluids. We prefer to feed breast milk whenever possible, and don't use formula without parental consent. Sometimes there will be a baby who is on IV fluids until there is enough breast milk if the parents don't want the baby to have formula, but we don't often have babies on IV fluids because of hypoglycemia.
  2. There seems to be a little confusion around the use of Dextrose gel - it is used as a treatment for hypoglycemia.I believe there are other studies underway looking at other ways to use it, but this is how our unit has used it for many years now. We give 0.5ml (cc) per kg of bodyweight applied directly to the buccal membranes with a gloved finger. The baby will then be fed and the BGL checked in 30 minutes. We have not noticed any rebound hypoglycemia. I am not sure what is meant by Asymptomatic hypoglycemia - in our experience checking the blood glucose is the only way to ascertain whether a baby is hypoglycemic or not.
  3. We also use Atropine, fentanyl and suxamethonium. The only time we don't premedicate for intubation is in an emergency situation where it is not possible to adequately ventilate the baby by bag and mask or Neopuff.
  4. We don't use sedation either - well fitting prongs and hat, positioning, swaddling, pacifier, occasionally a little dextrose gel. Meticulous nursing care and attention is essential.
  5. We use 21% for term babies and titrate up according to response. For preterm babies (<34 weeks) we start at 30% and titrate as needed. We would only start in 100% if the baby was apnoeic with a heart rate < 60 bpm. These are the ANZCOR guidelines, released early this year.
  6. We move the probe to another location every 4 hours to avoid damaging the skin, and document the location on our records sheet.
  7. We do not refrigerated dextrose gel as the manufacturer tells us it is not necessary. We draw it up in a new syringe as needed. The bottle is discarded one month after opening. We have never had a problem with contamination, and as far as I know there are no preservatives in it. The manufacturer would be able to give you this information.
  8. Only if there are signs of respiratory distress.
  9. Hi, we use CPAP and high flow via nasal cannula. We extubate infants from HFOV straight to CPAP.
  10. We use only sterile water. Some of the things that we have noticed causing rainout are: room temperature fluctuations; if the temperature probe enters the circuit outside the incubator (temperature gradient causes condensation in the tubing between the temperature probe and the baby); and position of the tubing and circuit - the humidifier must be lower than the baby and the tubing should be angled so that it runs away from the baby. We have not noticed any increase in infection because of rainout, but the nurses do need to be vigilant in checking the position of the circuit and removing condensate before it gets to the baby by lifting the tubing so that the water drains back into the humidifier. We have worked closely with Fisher and Paykel to refine and troubleshoot the system. My feeling is that you would still get condensate in the tubing using acetic acid in the water, and I would be more concerned about this getting into the baby.
  11. Hi Stefan We have used fentanyl for many years now, at I think 4 - 5 mcg/kg. We dilute 100mcg of fentanyl with 6 mls of sterile water and draw up the dose from this solution, then give slowly over 5 minutes. We also give the flush slowly over 5 minutes. We rarely have problems with chest stiffness, and when we do, it seems that it is because it is given too quickly. We also use atropine but our muscle relaxant of choice is suxamethonium - fast acting and short duration.
  12. The study was carried out in the hospital where I work. In the special care nurseries (Level 2) we have used it for many years with very good results. We are all very proud of Deborah Harris, who was the lead researcher. During the study the gel was administered by both midwives and nurses, depending on whether the baby was in the post-natal wards or the NICU. We dry the buccal mucosa with a gauze swab and "massage" the gel into the mucosa with a gloved finger. The babies did not seem disturbed by this, and as the study results show, it works very well.
  13. We use 0.45% saline with hwparin 1unit/ml running at 0.5ml/hr for UAC or 0.8ml for PAL
  14. If we can't get the UVC into a high position, we remove it and insert a PICC line, within 24 hours if possible.
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