FMC specific routine and policies

Work Tid bits

What are the category for doing cUS?

1. Less than 33 weeks

Why do we hold iron for 2 weeks after transfusion?

Because

What are we looking for when we do cranial ultrasound?

Brain Bleed

Whats PVL and when do we look for it?

It is

When are mothers tested for GBS

Around ___weeks to ____

What are we looking for when we test for GBS? And how does it affect mom or baby? Do we test baby separately if mom was positive?

For the presence of Group B Streptococcus bacteria in the vagina and rectum. If baby is tested positive, it may require antibiotics during labor to prevent infection. Testing is done to prevent potential infections in newborns and assess the risk of GBS transmission during delivery, which can lead to serious health issues.

What is the difference between DiDi Twins, McDa twins?

DiDi twins are identical twins formed from one fertilized egg that splits into two, while McDa twins are fraternal twins that develop from two separate eggs fertilized by two separate sperm.

tWIN TO TWIN TRANSFUSION is what?

A serious condition in multiple pregnancies where blood flow between twins is imbalanced, often leading to health complications for one or both twins.

What do you often see in the donor twin versus recipient twin?

Donor twins

What are the stages of TT?

Based on the severity, TTTS is classified in five stages:

• In stage 1, there is oligohydramnios and polyhydramnios.

• At stage 2, the donor twin's bladder is not visible.

• Progression to stage 3 involves further hemodynamic changes, noticeable with Doppler examination. At this stage, the situation is critical and heart failure may occur, says Dr. Schenone. The fetuses require prompt intervention and the risk of fetal loss without intervention reaches 75% to 100%.

• Stage 4 is characterized by the presence of fetal hydrops.

• The last stage, stage 5, indicates at least one twin has died.

What is the pattern for giving Vit K (PO) if parents decline IM?

required 3 dose regime: 

Day 1 of life, at 1-2 weeks of age, and at 4 weeks of age.

Why do we use the blue sheet aka burn sheet?

protect the premature infant’s fragile skin from friction injury

What does Servo increasing or decreasing mean?

Increasing Servo
A consistently higher than baseline Servo indicates more flow is required to fill a larger space while maintaining the same set PIP.

It could mean
1. Patient may be improving, potential to wean support.

• Improved Compliance • Less Airway Resistance • Increased ETT Leak • Condensation in the Pressure Line • Cracked LifePort Adapter • Leaks in Jet or CMV System

Decreasing Servo
A consistently lower than baseline Servo indicates less flow is required to fill a smaller space while maintaining the same set PIP.
It could mean worsening compliance or increased resistance leading to a decrease in delivered Vt and may require an increase in set PIP

• Worsening Compliance • Increased Airway Resistance • Kinked or Obstructed ETT
Patient is worsening, may indicate the need for suctioning or the need for increased support • Right Mainstem ETT • Kinked or Obstructed Jet Circuit

What does servo measure and why does it fluctuate?

• It is a representation of flow through the Jet circuit needed to establish and maintain set Jet peak inspiratory pressure (PIP)

• May be related to changes in tidal volume or minute ventilation.

It fluctuates
- Servo will normally fluctuate due to spontaneous breathing.

Both Convectional and HFJV provides oxygenation and ventilation. Which one does what and through what functions? Can both deliver FiO2?

o Ventilation is the primary role of the Jet using Jet PIP, Jet Rate, Jet iTime.

o Oxygenation is the primary role of the CMV through use of PEEP and occasional recruitment maneuvers.

o FiO2 is delivered by both the Jet and the CMV.

How does High Frequency Jet ventilators work?

Conventional deliver large tidal volume over long inspiration time (High iTime) this volume reaches distal airways (the little capillaries from the alveoli) especially in small delicate airways and fragile alveoli. This also lead to restricting pulmonary flow and creating pulmonary air leaks


but Jet uses small tidal volumes and short inspiratory time to create lowest peak and mean alveolar pressure. It allows air leak to heal, and the inspiratory time stays the same even when rate is changed. I:E of 1:12 so there is less gas trapping. Passive exhalation is also possible through exhale gas (as the flow is less resistance thaks for the gentle delivery of tidal volume)

LAT
1. Make sure family is aware of move (check with Unit clerk, bedside etc) If you have to call - what do you discuss with them?

Give them transfer site information
1. Unit, Floor, contact person, and what to expect.
PLC 3rd Floor; ACH 4th floor; FMC 5th floor, RGH 6th floor, SHC 7th floor
2. Pay for day parking and then plan to visit parking office for long term rates

3. You can also share site specific info pamphlet with families (from flow co-ordinator)

4. Tell them baby is secured in transfer incubator and is continuously monitored throughout transfer (they usually enjoy the ride and sleeps throughout with the white noice") with a nurse and EMS crew present

Now you have to prepare the baby & belongings. Where do you start and what do you do?

1. At least one ID band on baby (Double check with another RN and don’t forget to document on CC)

2. Confirm if any consults or follow up that can be provided in reviewing site (ROP, hearing screen RSV etc)

3. Physical assessment have been done by neonatologists

4. Decide what your feeding schedule would look (For Long distance, are we feeding over 3 hours and what does the team want to do per hour)

5. Baby’s belongings and EBM packed

6. Make sure reports have been given to receiving site, if on the phone report is not possible, in person handover can be done at receiving site

7. Call receiving site for estimated arrival time

Now everything is good on baby and bedside’s end as well as parents. What about logistics ?

1. Bring incubator to bedside 45 mins prior to departure time.

2. Incubator is plugged in and “AC” light is on when plugged in (at all times even in the ambulance)

3. Isolette is usually set to match baby’s isolate temperature. If baby was in a cot, them incubator can be set roughly 25-26 degrees)

4. If going out of town, increase temperature by 1-2 degrees

O2 Tanks
1. There should be 2 tanks. For out of town trips, both tanks should be at 2000 psi

2. For in town trips, 1 tank at 2000 psi and the other above 1000psi

Neopuffs

1. Appropriate mask

2. Use baby’s bedside tubing & mask for transfer

3. Safety checks with O2 tank at 8LPM, 20/5

Suction

1. Your first line of suction is bulb suctioning (in transfer supply bag)

2. 2nd line of suction is on the ambulance (so on the EMS truck, ensure extension tubing is in place, set suction level to 80-100 mmHG and complete safety checks prior to departing sending site)

3. Also make sure you have 10mls feeding syringe for gastric decompression

Don’t forget baby’s stethoscope and thermometer (both need to come back to sending site)

Make sure transfer sourly bag has the green tag “checked and ready”

Monitors & Cables
1. ECG & Oxygen Sat can be monitored during transfer
2. Alarm limits are set

IV pumps & lines
1. Make sure rates are double checked with another nurse before departing (once baby is in the incubator)
2. Trace lines from source to site
3. Make sure you have enough volume of IV fluids for the trip and clear pumps prior to leaving for adequacy of amount baby got during the trip
4. Pumps should be plugged into the power bar on transport incubator and charging