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RMM last won the day on December 24 2020

RMM had the most liked content!

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About RMM

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  • Birthday 09/10/1979

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    Mater Health Services
    Brisbane, Australia
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    Brisbane, Australia

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  1. Hi All Thanks very much for all of those responses - it is interesting to see that we are not the only unit struggling with this phenomenon as we extend the limits of both gestational age and weight! Prof Jane Pillow's book on HFOV is certainly a well-read resource. Just a few further comments: - we would normally extubate a baby from HFOV at those low settings rather than de-escalating or weaning to CMV first - the issue we have sometimes is that on initial echo (usually done in the 1st 12-24hrs of life) there is often persistent transitional circulation (PPHN if you will) wit
  2. Just wondering what experience fellow practitioners have when oscillating ELBW babies with the Drager VN500 and using VG? We have a 425g baby who is being gently oscillated with Hz 15 , VG = 0.5ml (lowest setting available), set amplitude of 10 and only requiring amplitudes of 5-7 to achieve volumes. Running with pCO2 in low 40’s/high 30’s. Still in 30% oxygen with MAP of 10. Not keen to extubate quite yet. Has anyone used Hz >15? Any thoughts would be greatly appreciated.
  3. A problem that most units would see when looking after babies at the extremes of viability. We have used HFOV + VG (VG 1-3mL/kg) to manage these babies and generally don't have to reduce the frequency below 10Hz. Using "Sigh Breathes" can also be useful in these babies but like another poster suggested, using an early DART course may be useful as well as treating other underlying co-morbidities e.g. anaemia, VAP, PDA etc. This is taken from Prof Jane Pillow's manual on the use of HFOV that is published by Drager. Just thought it would be worth sharing. Let us know how you get
  4. This is an extract from Prof Jane Pillow's book on HFOV and its applications: You can access the entire publication free of charge from this website - https://www.draeger.com/Library/Content/hfov-bk-9102693-en.pdf - most definitely worth reading! I hope that is helpful! Kind regards
  5. Hi Antoine Thank you for the reply. Yes - outborn infants will always remain a problem for us, as we have many referral centres that look after newborn babies and refer to our tertiary centre for ongoing management. I live in Brisbane, Queensland and the state of Queensland has an area of 1.853 million square kilometres. It is nearly five times the size of Japan, seven times the size of Great Britain and two and half times the size of Texas. The states total population is just over 5 million. We only have 4 NICU's in the state that are capable of providing therapeutic hypothermia fo
  6. This is not an uncommon dilemma. We have developed a one paged trigger/ assessment tool for babies who meet criteria for monitoring for moderate or severe encephalopathy. It seems to work most times and one of our fellows is conducting an audit to see if we miss any babies with this tool. Based on this case, it sounds like the baby would have met criteria for clinical monitoring for moderate or severe HIE i.e. prolonged resuscitation and possibly Apgar scores? but not pH or BE related values and we would have then assessed this baby hourly for the first 6 hours of life for clinical signs
  7. I am one of the co-site PI's on a RCT called PAEAN (https://clinicaltrials.gov/ct2/show/NCT03079167). It is a multi centre, RCT looking at the use of EPO in babies with moderate or severe HIE that receiving therapeutic hypothermia. We are approximately 2/3 through recruiting for this study and hopefully these results can answer your question! Sorry, no answers but thought I would share that!
  8. I would have to agree with previous comments regarding abnormal position of this UVC. We also do cross-table lateral views when inserting our umbilical lines but if we have any doubt with that we will get an USS done to confirm position and then withdraw to a low position in the umbilical vein if other access is proving tricky!
  9. I was wondering if anyone had experience with using the AccuVein in the NICU at all? It looks like it used a lot in the adult and paediatric populations but I haven't been able to find any information regarding its use or suitability in the NICU? Would be great to hear feedback from anyone that has used it!! I have attached an information sheet as well as link to their website. Thanks Richard https://www.mundipharma.com.au/products/accuvein/? AccuVein info sheet.pdf
  10. Interesting discussion. Given we have had a explosion of 23 weeker a of late we are also having issues with chlorhexidine burns (use 2% solution). Very interested to hear that some centres only use 0.9% sodium chloride. This might be a very interesting practice to adopt!
  11. @spartacus007 I haven't as yet used it in a preterm infant but I could imagine there being difficult in getting the tapered dilator into the skin entry site over the guidewire. I think possibly a gentle twisting motion of the introducer over the guidewire might help get it into the entry site. Let me know if you come up with any other tricks when you try it again - trial and error I suppose!
  12. @spartacus007 do you mean the yellow tapered insertion needle that is in the microsite kit? I haven't had any experience of having this problem directly as the tip is tapered and so if the vein is of a generous size it should advance over the guidewire. I think twisting the tapered dilator that comes in the microsite kit as you advance it over the guidewire towards the skin insertion point may overcome that issue. As I mentioned previously we are using it in the bigger babies that require 24Fr double lines but have smallish veins! I hope that helps! Cheers Richard
  13. Our standard drug protocol is for semi-elective and elective intubations in the NICU include atropine, fentanyl and suxamethonium. The atropine to negate the associated bradycardia that this babies experience with laryngoscope insertion, fentanyl because it has a faster onset of action (although chest wall rigidity has been seen if administered to rapidly - we give it as a slow push over 2 mins & suxamethonium because of it's rapid onset of action and very short T1/2). I have not had any experience with the use of rocuronium or sugammadex in the neonatal population. I facilitate on th
  14. Thanks very much for that @spartacus007- that is a great video! Are you happy for me to share this with our junior staff?
  15. We are now using the Vygon micro-sites in our unit and with great success. Given the cost per pack we are using it for the bigger babies that require a 2Fr catheter because of the volumes. We have both 20 & 30 cm Premicath catheters for those babies less than 1500g and these seem to be working well. Thanks for the previous comments. I can highly recommend the Microsite packs!
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