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Good Afternoon,
I am interested in how your facilities staff for PICC line procedures: insertions, dressing changes, trouble shooting, removals etc. If your hospital uses bedside nurses for the procedures, who watches the inserter's patients? Who watches the patient having the procedure? Do you have any guidelines you can share?  Thanks.
~Angela Ramos RNC-NIC, BSN
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Hi, 
I am looking for good resource to learn Wound and Stoma care in neonate. 
Please, email me if you know. I would appreciate you. 

Yeoun Park 

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Hello,
 I am looking to see if anyone would share their protocols/guidelines for bubble CPAP, interested in the devices and cannulas used to provide Bubble CPAP ??? How long do ELBW infants stay on Bubble CPAP and what protocol /procedures are used for discontinuing ??? Thanks so much for your help.
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HI. We are looking for a needleless PAL device to draw blood.  I would appreciate any input from other facilities currently using this system.
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Hi everyone.

I was hoping to hear what some of the NICU practices are with babies that have been discharged and need to be readmitted. Do you readmit to the NICU? If you have an open NICU how do you decrease the risk of exposure to the other babies? Do you have a guideline of the max age you would bring back to the NICU? If they are readmitted to the Peds division do you place the Neonatologist on consult? Sorry for all of the questions.

Thank You

Theresa Martinez
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We have a policy to wear gloves for a specific population in the NICU (<1250gm or/& < 30wks), all IV care (peripheral or central) & any body fluid contact.  There is a push to wear gloves all the time for all patients with any contact, the only skin to skin touch will be with the parent when they visit.  Living in an evidence based world, I need supportive evidence for this argument.  
Does anyone utilize gloves all the time for all patients?  Do you have literature to support this?
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For the units using prolacta - when do you start your patients on multivitamins?


Thank you for your feedback,
Jennifer Boyle
jennifer.boyle@stjoeshealth.org
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Hi!  I would like to find out if there is any evidence to support wearing hospital-provided scrubs for NICU staff (i.e., decrease in infection rates)?  We are moving toward bringing our own scrubs to work and donning at work.  Is that what most NICUs are doing now?  Thanks so much for your feedback!  ~Laura Bravos  (laura.bravos@alexian.net)
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I would like to know what your procedure is for preventing gastric distention when CPAP is used.  How do you accomplish drainage to gravity, and what to you use to catch any gastric fluid drainage?  Thank you.

----------------------------------------------------------------------------------------------------------------

Sarah Bassett, MSN, RN
Laredo, TX
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A local hospital recently (May 2014) added 24/7 NNP coverage for their Women's Center.  They currently deliver low-risk 34 weeks and above and have averaged ~500 deliveries/yr.  With the support of NNP's/Neonatology,  the OB providers hope to increase those numbers and decrease the gestational age at delivery to 32 weeks in the future.  We currently attend all deliveries as support and to introduce the role to the staff and community.  Before NNP's, a pediatrician was on-call (not in-house) and would come from home or clinic for risky deliveries such as MSAF, vacuum extraction, NRFHT, etc.  Several pediatricians were lost due to dissatisfaction with this aspect of their job and the remaining pediatric group were instrumental in bringing NNP's on board.  
Administration is concerned with the cost of NNP's to the system.  Much of our shift is spent in support to nursing, assessing neonates, answering questions, education.  At night, if there are no deliveries, we have a call-room in which to sleep.  Administration/management would like us to provide nursing care to babies.  I am not opposed to helping nursing with neonatal care!  But, we are to be trained on the pixis so we can obtain vit. k, erythromycin, and hep b and give it to the babies after delivery.  We will have computer training so we can chart as the RN's do.  It is unclear what happens if there is an OB issue that we must attend while we are providing nursing care.  I am concerned and confused about my NNP role and would appreciate any comments, thoughts or advice. This seems to be a slippery slope! 
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NANN and NANNP are pleased to announce a Membership Scholarship Program for newly graduated NNPs.

The scholarships will provide one year complimentary NANN/NANNP membership to 20 newly graduating NNPs.  (Scholarship recipients must be graduates of an NNP program in 2014 or plan to graduate by May of 2015.)

 We encourage you to share the value of NANN/NANNP membership, along with this new scholarship opportunity with any NNP students or newly graduated colleagues you may have.  To apply for the scholarship, individuals may use this link. The deadline to submit an application is February 1, 2015.

 Please note that this program was made possible through funding from Abbott Nutrition. We thank them for their generosity.

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NANN and NANNP are pleased to announce a Membership Scholarship Program for newly graduated NNPs.

The scholarships will provide one year complimentary NANN/NANNP membership to 20 newly graduating NNPs.  (Scholarship recipients must be graduates of an NNP program in 2014 or plan to graduate by May of 2015.)

 We encourage you to share the value of NANN/NANNP membership, along with this new scholarship opportunity with any NNP students or newly graduated colleagues you may have.  To apply for the scholarship, individuals may use this link. The deadline to submit an application is February 1, 2015.

We are thrilled to be able to offer a membership scholarship opportunity to new graduates! Please note that this program was made possible through funding from Abbott Nutrition. We thank them for their generosity.
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Our NICU will sometimes have babies stay up to one year of age. We use NPASS scale for all of our patients but these patients are no longer neonates. Does anyone use a pediatric pain scale for patients in the NICU and if so which one? And at what corrected gestational age (>44 weeks CGA?) would you change the pain scale?
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We have recently been utilizing nasal trumpets in the management of pierre robin patients.  We had to improvise a system to keep them in place.  This requires placing a small hole in the outer tip of the trumpet, and threading umbilical ties through the holes,  and then taping the ties in place with tegaderm or use trach ties.  We would appreciate any protocol, procedures or guidelines that have been effective for anyone else.

Thanks

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Our Level 3 NICU has recently been recieving our post op patients back into our units with epidurals in place for pain management.  Because the RNs do not have a protocol for managing the epidural (operating the pump or changing out the medication bags etc), the anesthesiologist changes out the bags and changes the bags.  They would like the RNs to take over this responsibilities.  Do any other NICUs have any policies, procedures, our guidelines for RNs?   We would appreciate any input.

Thanks
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Anyone have a policy on capping and flushing the 2nd lumen on an umbilical linethe would be willin to share?
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We are looking at the hummi draw device and would appreciate any input from other facilities currently using this system.
Kim Deynaka
Director NICU
Tacoma Washington
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Need a reference for use of pulse oximetry(or not) in routine well baby phototherapy.

Facility is considering allowing for in room with parents for routine phototherapy.

Thoughts or feelings...

Thank you
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I was wondering what protocols other institutions have regarding the frequency of hands on assessments of our ELBW infants? We currently have a standing order for cares every 2-4 hours, and typically our feedings are every three hours. So, our 24-28 week babies on trophic feeds are handled every 3 hours, and if they are NPO they are handled every 4 hours. Occasionally, some nurses are able to make a case for a particularly unstable ELBW infant to be handled q 6 hours. I was wondering if q 6 hour hands on assessments could be a standard for our ELBW infants?  Based off what I have researched regarding developmental care of ELBW infants (cluster caregiving, only stimulate when infant is in an awake state etc.), and what I have heard at conferences I have attended, the frequency of our routine assessments is excessive. I haven't been able to find much research based articles addressing nursing assessment frequency specifically though, and I need to have evidence of what is appropriate before presenting to our Local Practice Council. If anyone has feedback, suggestions, or research articles that could support a standard of practice or protocol for nursing assessment frequency I would
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The NANN position Statement for the Palliative care for newborns and infants recommends that parents are part of the caregiving team and should participate in the decision making process. It referances the use of a family medical record (e.g.,the Penticuff Family Medical Record, Penticuff & Arheart, 2005). Using this tool allows families to track their infants progress and better understand when the infant is not "getting better".  I  have found the tool, but can not find directions or education for the use of the tool. Can any one help me, or aim me in the correct direction? Thanks
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