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Newborn Transport A Closer Look

Newborn Transport A Closer Look. Author: Patricia Muncey RNC, BSN Updated presentation: Susan Greenleaf RNC, BSN. Objectives:. Discuss what happens when the transport team is called Identify what the referring units need to have ready for the transport team

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Newborn Transport A Closer Look

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  1. Newborn Transport A Closer Look Author: Patricia Muncey RNC, BSN Updated presentation: Susan Greenleaf RNC, BSN

  2. Objectives: • Discuss what happens when the transport team is called • Identify what the referring units need to have ready for the transport team • Understand what goes on when the transport team arrives • Discuss how to help the parents when their infant is transported

  3. The TGH Neonatal Transport Service – Who Are We? • Regional center for high risk OB and Neonatal services • Coverage area • Southwest Washington • Ground-only transport • Team composition • Transport Medical Director • RNC, RRT, and EMT • The occasional visitor

  4. Who Are We ….. • Statistics • Consultation vs. Referral

  5. What Happens When the NTS is Activated • Physician to Physician • Consultation vs. Referral • Need for delivery attendance? • Charge Nurse to Charge Nurse • Bed space • Staffing considerations • Reasons for deferring to Seattle

  6. What Happens….. • Team Response • To TGH within 30 minutes • Leave TGH within 45 minutes • Rural Metro and our Rig

  7. When the NTS Arrives • Our approach • First priority is always the patient • Teaching opportunities may need to wait • QA process… • Plan of care dictated by patient status • Teamwork is everything • Timing is everything • Collaboration is everything

  8. S = Sugar • NPO – if it’s too sick to stay, it’s too sick to eat • Risk of aspiration • Poor intestinal perfusion • Increased energy demands & consumption • IV Access • D10W @ 80ml/kg/day • Bolus 2ml/kg • Indications for UAC/UVC

  9. T = Temperature • Heat loss – the famous 4 • Conduction, convection, evaporation, radiation • Those at greatest risk • Detrimental effects of cold stress • Acidosis • Increased metabolic rate • Increased O2 consumption • Process for re-warming

  10. A = Artificial Breathing • Please place me prone! • Indications for NCPAP • Indications for intubation • Proper ET size is everyone’s responsibility • Proper placement is everyone’s responsibility • Use of sedation

  11. B = Blood Pressure • Causes of hypotension • Hypovolemia • Cardiogenic or Septic shock • Prematurity • Diagnosis – history, S/S, labwork • Treatment • Volume expansion • Blood • Vasopressor

  12. L = Lab Work • Minimum: • Blood culture (before antibiotics) • CBC with diff • Blood gas • Blood sugar • Any & all prenatal lab work on mom • HIPAA concerns

  13. E = Emotional Support • Accompany the team to the parent’s room • Help clarify team explanations • Ask the team to identify TGH personnel if possible • Ask the family if you can call support people for them • Take pictures of infant

  14. E = Emotional Support… • Call infant by first name • Offer follow-up call on arrival at TGH • Find out if mother is planning on breastfeeding

  15. What We Need from You • Prenatal Information • Maternal prenatal lab work • Prenatal history • Delivery Information • Resuscitation efforts • NRP! • Newborn care • Physician summary

  16. What We Need…. • All newborn lab & blood gas results • Blood culture to TGH? • No longer take maternal blood • X-rays • Copies of all x-rays • Validates or clarifies diagnosis • Verification of our ETT and CL placement • Decreases exposure to radiation • Breast Milk on ice

  17. What We Need… • Admit meds given? • PKU and Hep B vaccine? • And on behalf of our EMTs…… • At least 2 face sheets please!

  18. QA Process and Education • Summary to TGH physician before departing • What triggers a QA memo • Clinical concerns • Low pH, low temp, intubation in route, resuscitation in route, expiration • Equipment failure or not available • Communication concerns • Education need

  19. And Last But Not Least…. • THANK YOU • THANK YOU • THANK YOU • We wouldn’t have such great patient outcomes without you!

  20. References Karlsen, K. A. (2001). Transporting Newborns the S.T.A.B.L.E. Way. (2001 ed.). Park City:Author

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