I hate to float

I'm a NICU nurse. I like my relatively controlled environment. Yes, I know many of you think I'm totally certifiable for that preference. I hate to float, as in to another unit. Something always happens to make me very sorry I've left the relative safety of the NICU.

Most recently, it was the pediatric unit and the 6 week old with an admission diagnosis of ALTE - apparent life threatening event. According to the mom, baby simply turned blue for no obvious reason. Only as Dr. House says, everyone lies.

The mom insisted that the baby was not feeding when the episode occurred, so the baby got the inevitable big deal workup for ALTE - cultures, LP, various scans and studies.

We all had our doubts about the mom's story, but they grew as the shift progressed.

8 pm: Charge nurse walked into the room and found mom feeding the baby -- baby was lying in the crib, mom was standing beside the crib holding the bottle. Charge nurse instructed mom to sit in a chair, handed her the baby and explained WHY feeding a 6 week old infant who is lying in his crib puts him at risk for choking episodes - which tend to make the baby turn blue and experience the above mentioned ALTE. Mom appeared to listen and finished feeding the baby while holding him.

Midnight: I walked into the room and again found mom feeding the baby in the crib - standing beside the bed, only this time she'd propped the bottle and was standing beside the crib watching the baby. I removed the bottle from the baby's mouth and went over the whole explanation about choking and ALTE's (mom still denied that baby was eating when said event occurred). Mom picked up baby, sat in chair, finished feeding without incident.

12:30 am: The pediatric resident stopped in to see how things were going. I updated her on the situation and documented VERY carefully while the resident went in to have another chat with mom. Social service consult was ordered.

2am: Mother of another patient stopped by the nurses station. She had seen the baby's mom and dad. She said they were relatives and there were some things we really needed to know. Charge nurse and pediatric resident escorted her to a private place for further discussion. Social service consult was ordered.

5am: I opened the door of the patient/parent bathroom on the floor (no locks, no response to knocking). Baby's father was pink, breathing, and sound asleep seated on the toilet. I closed the door and left.

5:30: I entered the baby's room again. Mom was snoring gently in the bed on one side of the room. Baby was lying in the crib, sucking on a bottle of formula. I removed the bottle from the baby's mouth, quickly assessed him to make sure he was OK, and took a deep breath to compose myself. Then I moved over to the mother's side and said:

WAKE UP!

Mom regained consciousness with a start. I explained, none too gently, that her baby could easily have died if she was in the habit of feeding him this way at home. She insisted that the baby's father must have propped the bottle. From the bathroom. Right.

If the mom had admitted to her unsafe feeding practices, the baby could have been observed and much of the uncomfortable and expensive workup would have been unnecessary. What was she thinking!

Good Reading

Change of Shift celebrates Valentines Day at Nurse Ratched's Place.

You'll find Grand Rounds at Tales from the Emergency Room

And in the better late than never category, Pediatric Grand Rounds was posted at Unintelligent Design last week.

IV Therapy Escapades - Part III

Valentine's weekend, as the song says, Ninteen-ninety-something. The patient had just been moved to the floor from the ICU. The admission was for pulmonary embolus and his heparin drip had infiltrated. Two IV therapy nurses had already been tossed out of the room and the general consensus was rapidly coming around to "Let his doctor start it." Not one to pass up a challenge, I volunteered to give it a try.

I looked at the rather grumpy patient in the bed, shot him my best Sally Sunshine smile, and quipped, "This is one hell of a place to spend Valentine's Day."

To my surprise, he actually smiled. Then he said, "You don't know the half of it, honey."

Normally, I don't respond well to "honey," but I was in the room unpacking my IV gear and he'd shown no signs of tossing me, so I encouraged him to continue. He certainly hadn't planned on being in the hospital for Valentine's Day. He hadn't even planned on being in town. What he had planned was a wedding - and a honeymoon in the Carribean. The ICU nurses had helped arrange for the wedding in their unit, but there was really nothing we could do about that honeymoon. Unfortunately, when he was transferred to the floor, his newlywed status hadn't been passed along, so his nurse had no idea why he was so unhappy.

As he continued to vent, I applied the tourniquet, cleaned the chosen site, inserted a 22 gauge catheter, secured it, and got his heparin drip running again. On my way out, I updated his nurse on his situation - and as I left, she was taking steps to ensure that the empty bed in his double room would stay that way as long as possible.

This is part 3 of a very occasional series. You'll find part 1 and part 2 in the archives.