NICU Standing Orders KFAFH

8/11/2019 NICU Standing Orders KFAFH

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King Fahad Armed

Forces Hospital

Neonatal Intensive CareUnit Standing Orders

NUR07.041


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Policy:Standing orders for

medication or investigations are

carried out by the NICU nurses

to expedite treatment and

enhance recovery.


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Procedures:


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Blood sample collection area


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Vaccines


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Hepatitis B vaccine

0.5ml intramuscularly

given prior to discharge, except for infants less than 1.7

kg


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Bacillus CalmetteGurin (BCG) Vaccines

0.05 ml intradermally

prior to discharge, except for infants less than 1.7 kg


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Respiratory Syncytial Virus (RSV) vaccine

15 mg/kg intramuscularly

All babies born at 32 weeks gestational age and below

All babies with Cardiac Conditions, Chronic lung

disease


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Eye Drops for Dilatation:

Given prior to eye

examination by

opthalmologist:


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Midriacyl 1%

- Apply one drop ineach eye for 3 doses

with 10 minutes

interval between each

dose. To be started

one hour before the

examination once the

opthalmologist called

to confirm his/her

arrival time in the unit.


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Phenylephrine Hydrochloride 2.5%

1 drop to each eye 10 minutes

for 2 doses to start 1 hour

before the examination once theopthalmologist to confirm

his/her arrival time.


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Both drops are used alternatley for

a total of 5 doses collectively


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Vitamin K:

1 mg intramuscularly for

all newborn babies (if not

given in labor ward or

operating room)


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Intralipids:

If the order is 20% and the pharmacy issue 10%, then

double the rate of infusion

If the order is 10% and the pharmacy issue 20% , then

half of the hourly rate of infusion.

Intralipid infusion is not included on the total fluid intake

per day. It is givan as extra.


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Metabolic Screening:

Blood test for

tandem metabolic

screen is done for all

babies 48-72 hoursof age and the baby

is on full feeds.


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Serum Potassium Level:

Serum potassium level to be repaeted venously if

cappillary level is 6.0 mmol and above. If repeated

venous level is still 6.0 mmol and above, then the

physician must repeat potassim level arterially.


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C02 for Electrolyte Result:

If the result from electrolyte is 18 mmol or less,

then blood gas must be done.


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Serum Bilirubin level:

If the baby is having

coombs positive, Rh, orABO incompatibility and

G6pd deficient, monitor

serum bilirubin level

after 12 hours of age.


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If serum bilirubin

level is whithin

photo therapyzone, start

phototherapy light

according to the

result.


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Babies with Diabetic mothers:

Gestational diabetic mothers taking insulin, their babies

must be admitted in NICU and monitor their blood glucose

levels.


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Do initial dextrostics.

Then hourly x3, (if dextrostics is 2 mmol/L 6.8 mmol/L)

Then every 3 hours x3 (if dextrostics is 2 mmol/L

6.8

mmol/L)

Then every 6 hours x3 (if dextrostics is 2 mmol/L6.8

mmol/L)

Every 12 hours


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All dextrostics should be done before feeds.


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Rule out Bacteremia:


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GBS positive mothers,

Spontanous Rupture of

Membranes > 18 hours, with

single dose or no maternal

antibiotics received


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Complete Blood Count , C-Reactive Protein daily for 3

days

SBR done 24 hours of age. If the baby is havingcoombs positive, Rh, or ABO incompatibility and G6pd

deficient, monitor serum bilirubin level after 12 hours of

age.


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If baby is meconium stained, no need

to extract blood for CRP.


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MRSA Screening


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Babies requiring MRSA screen:

(swab for nose, axilla, groin)

Every 2 weeks for all babies delivered in

KFAFH Operating room and labor ward.

All Babies transferred from outside hospital Babies delivered at home. (includes cord

swab)

All babies who stayed in Well Baby Nursery

for >12 hours then admitted to NICU.


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Test for clearance:


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Swabs of the nose,axilla, groin and othersites previouslypositive should betaken 3 days apart.Three negative seriesof screening tests arerequired before the

patient is consideredto be clear.

Babies should not bereceiving antibiotictherapy throughoutthe screeningprocess.


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Antibiotic BACTROBAN OINTMENT(mupirocin)

Ointment, 2% is given for 5 consecutive days, then a

swab from the previous positive site should be

taken.


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Thank You for Listening

E t th h l i

NICU Standing Orders KFAFH

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