Friday, June 10, 2005

One, two, three......four, five!

I work in a level 3+ NICU. We do nearly everything the largest NICU's do except some of the more complex surgeries and ECMO. We're not one of the biggest ones, our average census is 12. On any given day, we have anywhere from 3 to 23 babies actually in the NICU. Life is painfully boring at times, and a frantic whirlwind of activity at others. Fortunately, we have several staff members who are willing to come in at a moment's notice when it starts hitting the fan. Oh, and thank God for agency nurses who'll do that too!

On a recent night, we started the shift with 11 babies and 5 nurses. The board in the birthing center was full, and I was the lucky person in charge. It was looking like an average, reasonably steady night. Looks can be deceiving. The outgoing charge nurse mentioned that the only apparent "threat", the mom of the triplets had been having a few more contractions, but the perinatologist was hoping to get her quieted down again. He'd been able to do that for 6 weeks, so we weren't too worried. Everyone else in the birthing center was either full term or delivered already.

I made out the patient assignments and the phone started ringing as I tried to get 8pm cares done on my patients.

First, the nursing supervisor: Did we want an extra nurse for night shift? One of the agencies had called to offer us one. There was one nurse from the pediatrics unit available to relieve the evening shift nurse in the step-down room with the bigger babies, but nobody else if the triplets came. It was Memorial Day weekend, so only one of the nurses willing to come in on short notice was in town and not already working. I asked the agency nurse's name and immediately agreed to add her to the staffing pattern.

Moments after the nursing supervisor hung up, the birthing center called. We had an hour to get ready. Triplets. 28 weeks.

We've done this enough that we have it pretty much down to a science, but it's always an adrenaline rush. The admission warmers had been set up for days. The respiratory equipment was in place, and we knew who we needed to call. The back-up nurse quickly agreed to come in and even arranged for a secretary to come with her. She arrived just in time to check her admission bed and get her gown, cap, mask, booties, and gloves on and head over to the OR with the rest of the team: 2 more nurses, 3 respiratory therapists, 1 nurse practitioner, 1 neonatologist, and 2 pediatric residents. Once we were in place, the OB started and we very quickly had the babies stabilized and ready for transfer.

We have 3 transport isolettes, but we prefer to use our lightest one for trips around the corner from the OR to the NICU. As charge nurse, I had shuttle duty. That was my aerobic exercise for the night, or so I thought. The triplets were quickly settled into place, lines inserted, and respiratory support in place. They were started on CPAP, continuous positive airway pressure, to help keep the lungs expanded and ease breathing. The remaining staff adjusted assignments to cover the other babies. Things were looking good. Did I mention that looks can be deceiving?

The evening nurse offered to stay over a couple of hours if we needed her, but the triplets had been settled in so quickly that it didn't appear necessary -- until she tried to walk out the door. I caught the call from the birthing center just as she walked past me. Another patient had just arrived, 34+ weeks, in very active labor, 4-5 cm dilated and the first baby was breech. We had about 30 minutes to set up for that delivery. I interrupted the report to shout at her receding back "Please don't go!"

Did I mention that I love my co-workers? She stayed. Until 5.

At 34 weeks, babies can be practically ready for the well-baby nursery - or they can be quite sick and need full ventilator support. More commonly, they're in the middle. They just need CPAP. We had used the last of our older machines for the triplets and there was no time to rent, so we quickly got approval to bring out two new machines we'd just been oriented on - a couple of days ahead of schedule. Kudos to our respiratory therapy department for having them ready!

That delivery went smoothly, and thanks to the additional staff, we made it through the night. A week later, all 5 babies were doing well, but the census had expanded to 18. This could be a long summer, but I certainly won't be bored.

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