Learning to swaddle an infant well is a skill. It is not something anyone is just born knowing. It isn't something you suddenly know when you first have your own children. In the NICU it is a HUGE necessity.
Why swaddle?
It calms the babies. It makes them feel secure, safe and less stimulated.
Why so tight?
The tighter the better, I think, with some kids. Especially those who are withdrawing from some form of drug. When teaching new nurses to swaddle, I show them first to make a diamond shape from the receiving blanket. Then fold down one corner. Then put the baby's head at that folded corner and tuck one arm in the fold and wrap it over them and tuck it under. Pull up the bottom corner, tuck it over their opposite shoulder. Then, and this is the important part, take the other arm and hold it down while you pull the remaining opening over the baby toward you and chinch it tight. You want the baby to go "Uh!" as you pull. It is a lot like saddling a horse. If you don't pull it tight enough the saddle slips off. If you don't pull the blanket tight enough, the baby escapes and then... oh and then. The wrath of God is less than a drug addicted baby who has just escaped from her swaddle.
Of course you can get a little over zealous. I had a baby once after I first started who was continually desating (dropping the level of oxygen in her blood stream... it makes the monitor alarm and means the baby isn't getting enough oxygen). She was a drug baby. She had no other issues, and she had been relatively healthy up until this point. She was screaming early in the night and I asked a friend who is known for her wonderful tight swaddles to help me wrap her. So after a few times of the alarm going off, I went over to the baby and unswaddled her to check her monitor probes were in the right position. As I untucked the tight swaddle I heard the baby take a huge gasp of air. Ok, maybe that swaddle was a little overboard. But she hadn't cried. Of course, she was having a hard time breathing, but at least she wasn't crying. Anyway, we fixed it and she was fine.
So swaddle... tightly... but not too tight.
Tuesday, January 29, 2013
Thursday, January 24, 2013
Neonatal Nursing Year One
I've just completed my very first year as a registered nurse. I work in a level 3 Neonatal Intensive Care Unit that is the regional referral center for our state. We have, on average, 50 patients at any given time. We take only newborns who have never left the hospital and only up to age 6 months. At that time they would be transferred to a Pediatric Intensive Care or a long term care facility if that was needed. I adore my job. And it is the hardest thing I've ever done.
Things I've learned in the first year as a neonatal nurse:
1. Night nursing is NOT for sissies! Yes, it can be a little quieter at times than days, but the positives can also be drawbacks. No doctors around ... even sometimes when you really need them. No parents around ... so you get to do all the care for all the babies every care time. No specialities like interpreters or pharmacists or feeding therapists or lactation consultants or social workers ... so congratulations you are EVERYTHING.
2. Coworkers make the job better or horrible. I guess this is true in every job, but in the NICU you NEED people you can trust and who trust you. Lives literally hang in the balance and without trust nothing works. But when you click, it is wonderful.
3. Babies are completely unpredictable. I cannot tell you the times I've come on shift to hear a report that sounds like, "They've slept all day and had no episodes at all on room air." Then the first care time, the baby is starting to look septic and by morning the baby has had a full work up, been put back onto the ventilator and looks horrible. Of course, it can go the other way too, which is by far my preference.
4. Adults are crazy. Especially when it comes to their babies. Or their sister's babies. Or their children's babies. And many times we are made to be the "bad guy" because we have to tell them news they don't want to hear.
5. Some parents are amazing and loving and great to their kids and too many times their children do the worst in the NICU. It is some crazy cruel fate that befalls awesome people that their children are the sickest or even die.
6. Usually the parents whose babies are born addicted to drugs have the best luck in the NICU. Their children should have multiple issues, but nope... they don't... they are beautiful and perfect and once the horrible withdrawals are over they go home with their crappy parents and we all are left to wonder if they will be okay.
7. Some babies are not cute. I know... I know. But it is true. Some babies are simply NOT cute. Of course, I am the crazy nurse who usually falls completely head over heels for the ugliest babies in the unit.
8. Doctors don't know everything. And sometimes I think they don't know anything.
9. Neveah is not an original name. Nor should any awesome family name their child that. Neveah is a crack head's baby's name. Only. Please don't name your child this.
10. Nothing I learned in nursing school could have prepared me for what I see in the real world every day.
So, I'm going to blog about some of these experiences. I'm going to let you in on a tiny piece of the NICU world behind the scenes. I hope you enjoy it.
Things I've learned in the first year as a neonatal nurse:
1. Night nursing is NOT for sissies! Yes, it can be a little quieter at times than days, but the positives can also be drawbacks. No doctors around ... even sometimes when you really need them. No parents around ... so you get to do all the care for all the babies every care time. No specialities like interpreters or pharmacists or feeding therapists or lactation consultants or social workers ... so congratulations you are EVERYTHING.
2. Coworkers make the job better or horrible. I guess this is true in every job, but in the NICU you NEED people you can trust and who trust you. Lives literally hang in the balance and without trust nothing works. But when you click, it is wonderful.
3. Babies are completely unpredictable. I cannot tell you the times I've come on shift to hear a report that sounds like, "They've slept all day and had no episodes at all on room air." Then the first care time, the baby is starting to look septic and by morning the baby has had a full work up, been put back onto the ventilator and looks horrible. Of course, it can go the other way too, which is by far my preference.
4. Adults are crazy. Especially when it comes to their babies. Or their sister's babies. Or their children's babies. And many times we are made to be the "bad guy" because we have to tell them news they don't want to hear.
5. Some parents are amazing and loving and great to their kids and too many times their children do the worst in the NICU. It is some crazy cruel fate that befalls awesome people that their children are the sickest or even die.
6. Usually the parents whose babies are born addicted to drugs have the best luck in the NICU. Their children should have multiple issues, but nope... they don't... they are beautiful and perfect and once the horrible withdrawals are over they go home with their crappy parents and we all are left to wonder if they will be okay.
7. Some babies are not cute. I know... I know. But it is true. Some babies are simply NOT cute. Of course, I am the crazy nurse who usually falls completely head over heels for the ugliest babies in the unit.
8. Doctors don't know everything. And sometimes I think they don't know anything.
9. Neveah is not an original name. Nor should any awesome family name their child that. Neveah is a crack head's baby's name. Only. Please don't name your child this.
10. Nothing I learned in nursing school could have prepared me for what I see in the real world every day.
So, I'm going to blog about some of these experiences. I'm going to let you in on a tiny piece of the NICU world behind the scenes. I hope you enjoy it.
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