Page 1 of 7 Advocate Children s Hospital Job Instruction Sheet Micro Preemie (Less than 26 weeks) Shuttle Transfer Process from L&D to NICU Job Sequence Key Points Rationale Illustration Determine and gather any Preparation extra supplies that may be improves needed prior to departure to outcomes in the CHECKLIST L&D. time of crisis. BELOW 1 Gather supplies (See the list below of Isolette Supply Checklist). 2 Daily: Delivery RN needs to assure complete bed set up. RCP needs to assure respiratory equipment availability. Sign Checklist located in the red binder to verify task completion. Bed Set Up: Shuttle & bed are plugged in to the wall and warmed to 33 degrees Back into the store room and push out when needed Bring resuscitation cart to the room Frog in bed Supplies from #1 are with the bed Limb leads/pulse ox. available Infusion pump operational: brain, channel, & syringe module Respiratory Equipment: Verify PSI on one air and two oxygen tanks (One oxygen is for Hamilton ventilator and other oxygen/air is for shuttle) Calibrate ventilator Check T-Piece resuscitator Check ventilator circuit Verify suction tubing and canister are connected and operational Verify presence and function of resuscitation bag Verify respiratory tool kit is intact Adequate preparation improves patient outcomes.
Page 2 of 7 3 L&D calls for micro preemie delivery. L&D Instruction: Remove Panda bed from (Labor Room/ OR) increase room temperature to 74 degrees Fahrenheit NICU Instruction: RN: Remove bed from admission space Take a warmed D10W bag, erythromycin, & Vitamin K to L&D from the med room in the purple neighborhood Take blue resuscitation med box to L&D RCP: Take respiratory tool kit to L&D Take Curosurf - *In emergency/precipitous delivery utilize standard delivery bed setup Teamwork improves outcomes. Improving the room temperature decreases the thermoregulation loss to the VLBW infant. 4 Arrival in L&D Responsibilities. Nurse #1 responsibilities: Direct Care Provider Pre-heat bed to 35 degrees Plastic wrap with hood and hat on bed Plug in limb leads Attach pulse oximeter Attach temperature probe with duoderm Activate chemical mattress pad Place nest on chemical mattress pad
Page 3 of 7 Pour water into Giraffe bed to provide humidity Nurse #2 responsibilities: Secondary Provider Check room temperature for 74 degrees Fahrenheit Prepare for IV insertion Prime IV fluids RCP is responsible for: Plugging in oxygen tank Plug in shuttle Verify bed is plugged into the shuttle Prepare intubation supplies Physician is responsible for: Pre Brief team Pre Brief family Don sterile gown Discuss delayed cord clamping with OB Acquire sterile receiving bag Intubation in the Micro Preemie population is exclusive to the Neonatologist, Fellow, or Hospitalist. 5 The baby is delivered. Resuscitation per NRP guidelines Secure airway as assessment dictates. Attach temperature probe, limb leads, pulse ox, & set infant temperature at 37 degrees. The guidelines of Neonatal Resuscitation 7 th Edition will be followed.
Page 4 of 7 6 Infant stabilization Nurse #1: Obtain weight Insert IV (2 quick attempts) If able to place IV, complete next 4 steps; if unable, skip Initiate fluids Check infant s length, FOC Places OG Administer Vitamin K and erythromycin Goal for IV fluid administration is within 30 minutes of life 7 Preparing to leave L&D. Nurse #2: Prepare all supplies Obtain infant ID bands Physician: Determine need for intubation or NIV RCP: If intubated, deliver surfactant Transition infant to determined respiratory support (ET or NIV) Whomever has completed their tasks should provide containment Chest & abdomen measurements can occur after 72 hours. An available team member: Encourage first touch. Check infant s temperature before leaving L&D Encourage support person to accompany team to NICU Nurse #1: Assure adequate containment of infant prior to transfer Close Giraffe Top Use lung protective strategies when providing respiratory support. Ensure infant is delivered in optimal condition and family is well supported in the delivery process.
Page 5 of 7 8 Leaving for NICU. Unplug shuttle and all team members assist in shuttle/bed transport of infant to the NICU Team locations for shuttle transfer: RCP: near ventilator, right rear. RN: one left rear and one left front. Physician: Right front. Provide gentle, protective management. 9 Hallway transfer. Slow walk. Slow pivot at every turn. Slow movement over each floor transition Right front RN dictates team movement until arrival at bed space. No quick accelerations or decelerations as this may lead to an increase in IVH. 10 Arrival at bed space: RCP directs the slow pivot into the bed space. At this point, bed is plugged into headwall. Respiratory support is transitioned to the appropriate unit mode. Transition IV pump if necessary.
Page 6 of 7 Assure all disconnections have been made prior to disconnecting the shuttle. Nurse #1: Obtain glucose screening If no IV access, prepare for central line placement and complete admission process Nurse #2: Orient support person (if applicable) Team Allow infant to transition, as long as possible, based on infant s condition. 11 FAQ Plastic wrap with hood + hat: Small = 45 grams Medium = 50 grams Order Brain & Syringe module for admitted infant and place on shuttle Isolette Supply Checklist - (Delivery RN to check/stock isolette every shift) Infusion pump - Brain, channel, & syringe module on back of bed Thermometer and probe covers D10 bag (gathered at time of call) IV tubing 10 ml syringes (3) Med tubing Pin to spike D10 Pulse ox Limb leads Temp probe Duoderm cut for temp probe Hats (2) Plastic wrap with hood Warming mattress (2)
Page 7 of 7 Saline wipes Alcohol wipes Gauze Tape Suture removal kit Blankets Bulb syringe Frog (for transport) Tape measure 5 fr.ng tube 6ml purple oral syringe for venting Sterile water bottle for humidity Paper and Pen Supplies for IV start o Angiocaths o T-connector o 3 ml and 5 ml syringe flushes o Needless cap o Bio-occlusive o Rubber band o Armboard o Cleaning agent (chloraprep, etc.) Set Up Checklist RN #1 RN #2 Neo Check room temp is 74 degrees Fahrenheit Activate warming mattress, purple side down Place one blanket over mattress Place hats under mattress Open bulb suction Create standardized nest Connect temp probe to bed with Duoderm in place Turn bed to servo temp 37 degrees Lay out monitor leads Fill water reservoir for humidity Set up for IV insertion (t-connector, tape, flush, etc.) Hang D10
Page 8 of 7 RCP Set up plastic wrap with hood Set up T-piece resuscitation device and ventilator Have surfactant available Set up suction with suction catheter Prepare for intubation (ET tube, stylet, laryngoscope) Have ETT stabilization device available Keep flow inflating bag available (on the hook of bed)