Neonatal Network
January/February 2006
Vol. 25, No. 1

ABSTRACTS

Neonatal Intravenous Extravasation Injuries: Evaluation of a Wound Care Protocol
Doris Sawatzky-Dickson, RN, MN, IBCLC
Karen Bodnaryk, RN, BN

Purpose: To evaluate an evidence-based wound protocol for intravenous extravasation injuries in neonates.
Sample: Nine newborns with intravenous extravasation injuries. Birth weight: 582-4,404 gm, gestational age: 24-40 weeks.
Results: Five wounds were colonized with coagulase-negative Staphylococcus species, two with diphtheroids, three with Enterococcus. There was no evidence of wound infection or systemic infection. Rates of wound healing ranged from one to six weeks.

Implementation of an Enteral Nutrition and Medication Administration System Utilizing Oral Syringes in the NICU
David Copelan, PharmD, MPA, FASHP
Julie Appel, RNC BSN

NICU patients are at particularly high risk of harm and even death from medical error. In one NICU, a process change was undertaken to minimize the risk of errors resulting in the intravenous (IV) administration of enteral formulas and oral medications. In addition, a double-check system for medication doses was introduced to reduce the likelihood of medication errors. The previous practice was to deliver enteral formulas via syringe pump using IV syringes and tubing and to dispense medications in bulk bottles, drawing up patient-specific doses at the bedside. Converting to oral syringe delivery of medications and enteral formulas utilizing enteral-only tubing eliminated the necessity for Luer-Lok IV tubing and syringes, thereby reducing the potential for wrong-route error. Converting from dispensing medications in bulk to a unit-dose system permitted establishment of a double check system in which doses are first checked by a pharmacist and then checked by the nurse before they are administered. This article describes the planning, implementation, and postimplementation process required to make this change in practice a success.

Sound Level Exposure of High-Risk Infants in Different Environmental Conditions
Jacqueline F. Byers, PhD, RN, CNAA, CPHQ
W. Randolph Waugh, BS, RRT
Linda B. Lowman, MEd

Purposes: To provide descriptive information about the sound levels to which high-risk infants are exposed in various actual environmental conditions in the NICU, including the impact of physical renovation on sound levels, and to assess the contributions of various types of equipment, alarms, and activities to sound levels in simulated conditions in the NICU.
Design: Descriptive and comparative design.
Sample: Convenience sample of 134 infants at a southeastern quarternary children's hospital.
Main Outcome Variable: A-weighted decibel (dBA) sound levels under various actual and simulated environmental conditions.
Results: The renovated NICU was, on average, 4-6 dBA quieter across all environmental conditions than a comparable nonrenovated room, representing a significant sound level reduction. Sound levels remained above consensus recommendations despite physical redesign and staff training. Respiratory therapy equipment, alarms, staff talking, and infant fussiness contributed to higher sound levels.
Conclusion: Evidence-based sound-reducing strategies are proposed. Findings were used to plan environment management as part of a developmental, family-centered care, performance improvement program and in new NICU planning.


Embracing Bioethics in Neonatal Intensive Care, Part I: Evolving Toward Neonatal Evidence-Based Ethics
Isabel B. Purdy, NNP, CPNP, PhD

Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced-based medicine have often superseded standards in evidence-based ethics. Part I of this article presents a historical review of neonatal care and an overview of cases that have set precedents in neonatal ethical debate. It also includes recommendations for enhancing the skills of neonatal nurses as patient advocates in NICU ethical issues, an area that is, at times, controversial and baffling to clinicians.

Embracing Bioethics in Neonatal Intensive Care, Part II: Case Histories in Neonatal Ethics
Isabel B. Purdy, NNP, CPNP, PhD
Rita T. Wadhwani, RN, MSN

Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced-based medicine have often superseded standards in evidence-based ethics. Neonatal nurses attain a more in-depth understanding of the clinical significance of the four principles of bioethics: autonomy, nonmaleficence, beneficence, and justice. Case studies illustrate the principles discussed.