The endotracheal tube (ETT) is the most common artificial airway used in NICUs. Suctioning of the ETT is imperative to maintain patency and prevent complications. An extensive review of the literature revealed a lack of standardized criteria or guidelines for suctioning the ETT of neonates and infants in the NICU. The purpose of this article is to report the implementation of an evidence-based guideline that can be utilized in NICU care.
Persistent uncontrolled neonatal hypoglycemia may cause irreversible brain damage. Hyperinsulinemia is a rare cause of persistent hypoglycemia, diagnosed by excluding other etiologies. Inappropriately high fasting serum insulin levels with concurrent hypoglycemia confirm the diagnosis. Initial interventions for hyperinsulinemia are conservative. The first line of therapy is administration of adequate intravenous (i.v.) glucose to maintain serum or whole blood glucose levels at or greater than 40 mg/dl. When enteral feedings are tolerated, schedules and caloric concentration are adjusted. Pharmacologic therapy is added to facilitate weaning from i.v. glucose. The drug of first choice is diazoxide. Octreotide is added if diazoxide therapy fails. Partial or complete pancreatectomy is the final treatment option. Nursing care for infants with hyperinsulinemia must also focus on the support and education of families. Family education must be individualized and should cover feeding regimes, administration of medication, proper use of equipment, and care during illness.
Because the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) can cause neurologic sequelae with the potential to affect long-term outcomes, its prompt recognition and treatment are essential. Normally, antidiuretic hormone (ADH) is secreted when effective circulating blood volume is decreased. SIADH is marked by secretion of ADH in the presence of effective or normal circulating blood volume. This causes plasma hyponatremia simultaneously with plasma hypo-osmolality and inappropriate hyperosmolality of the urine. This article explains the pathophysiology of the syndrome; describes its diagnosis, clinical course, and treatment; and exemplifies the syndrome with a case study.
I am writing concerning an article titled “Neonatal Peripherally Inserted Central Catheters: Recommendations for Prevention of Insertion and Postinsertion Complications,” published in Vol. 27, No. 4 (July/August 2008), pages 245– 257. Of concern are Figures 3 and 4 on page 253 titled securing the catheter with adhesive skin closure strips and looping the catheter. The instructions and pictures demonstrate how to secure the catheter using skin closure strips and show the strips placed over the catheter. This is of great concern. The manufacturer’s recommendations on BD L-Cath System state the following on page 8 line 26, “Secure the catheter and dress the site with a sterile dressing. Tapes and securing devices should never be applied directly to the non-protected catheter.” This caution is echoed in the article titled “Tiny Patients, Tiny Dressings: A Guide to Neonatal PICC Dressing Change,” published in Advances in Neonatal Care, Vol. 8, No. 3, pages 141–162. The author states the following, “Some hospitals use skin closure strips. If these are utilized, manufacturer’s recommendations should be followed, and they should never be placed directly overlying the catheter to avoid catheter breakage and embolism.” The author supports this statement with the following reference, Frey AM. PICC complications in neonates and children. Journal of Vascular Access Devices. 1999: 17–26. It is clear that skin closure strips used to secure the peripherally inserted central catheter pose great risk and must never be applied directly over the catheter. Thank you for sharing this important information with your readers.
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