Advances in neonatal care : official journal of the National Association of Neonatal Nurses
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Placement of a peripherally inserted central catheter (PICC) is often complicated by the infant's small size and previous use of the peripheral veins, making the traditional means of insertion inadequate. New techniques and technologies, previously reserved for pediatric and adult patients, are now available for use in neonates and can enhance the practice of neonatal PICC teams. ⋯ A second useful technique, the catheter exchange procedure, allows insertion of a new catheter within the same vein when complications such as occlusion, breakage, or inappropriate position occur and require removal of the currently dwelling PICC. Clinicians caring for neonates and infants must continually update their knowledge and skill by incorporating new techniques into their practice.
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The need for conventional mechanical ventilation (CMV) is a common one in the neonatal intensive care unit (NICU). The goals of CMV are to facilitate adequate gas exchange, minimize the risk of lung injury/damage, decrease the patient's work of breathing, and optimize the patient's comfort. Although time-cycled, pressure-limited ventilation remains the most common CMV modality, volume-cycled ventilation, assist-control ventilation, pressure-support ventilation, and pressure-control ventilation are sometimes used in the NICU. ⋯ Although CMV is frequently life saving, it can cause complications if improperly used. Nurses are responsible for the ongoing assessment and care of infants undergoing CMV and are becoming frequently more involved in the weaning process of CMV. This article provides an overview of conventional ventilation, with a focus on common modalities, and ventilation-related nursing interventions.
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Review Historical Article
Fundamentals of phototherapy for neonatal jaundice.
Phototherapy is the use of visible light for the treatment of hyperbilirubinemia in the newborn. This relatively common therapy lowers the serum bilirubin level by transforming bilirubin into water-soluble isomers that can be eliminated without conjugation in the liver. ⋯ Proper nursing care enhances the effectiveness of phototherapy and minimizes complications. Caregiver responsibilities include ensuring effective irradiance delivery, maximizing skin exposure, providing eye protection and eye care, carefully monitoring thermoregulation, maintaining adequate hydration, promoting elimination, and supporting parent-infant interaction.
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Brachial plexus injuries (BPI) are usually readily apparent at or shortly after birth. Failure of caregivers to recognize and appropriately treat BPI may contribute to the risk of life-long neuromuscular dysfunction for the infant and represents a serious medical-legal liability for the delivery provider. This article is the second in a series on BPI and provides a standard classification and a systematic guide to physical examination of the infant with suspected BPI. ⋯ Pictures and video clips are provided to enhance the reader's understanding of the consequences of this injury and the potential for improvement with surgical treatment. Useful Internet resources for parents, focused discharge planning, and guidelines for appropriate monitoring and follow-up are provided. Advantages of early referral and management by a multidisciplinary team at a brachial plexus specialty center are discussed.
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Review
Linking the sepsis triad of inflammation, coagulation, and suppressed fibrinolysis to infants.
Sepsis continues to be a significant cause of morbidity and mortality in hospitalized newborns and premature infants. The pathophysiology and disease state of sepsis appear to be similar between adults and children. Both groups display symptoms that indicate a systemic inflammatory response leading to coagulopathy, hypotension, inadequate perfusion of peripheral tissues and organs, and, ultimately, organ failure and death. ⋯ Knowledge of the pathophysiology has important clinical and research implications. Unlike traditional antimicrobial therapy, new potential therapies, currently under investigation for the treatment of sepsis, target the cellular response rather than the invading organism. A more complete understanding of the pathophysiology of sepsis may also lead to diagnostic tools with improved sensitivity and specificity for early recognition and treatment.