Resuscitation Trolley

AIM:
To enhance awareness among nurses the importance of continously maintaining efficiency of the resuscitation trolley in Paediatric Units

OBJECTIVE:

To determine compliance and non compliance among nurses in maintaining efficiency of resuscitation trolley.

STANDARD STATMENTS:
All nurses must be ensured that all the equipments and drugs are safe and ready to use.

Purpose:
It is the purpose of cardio pulmonary resuscitation and management of other emergencies in the Paediatric Unit.

All nurses:

1. Are required to be familiar with the location, contents and operation of equipments and supplies on the resuscitation trolley.
2. Will participate in checking the contents of the resuscitation trolley and ensuring daily checks of the resuscitation trolley.
3. Maintaining the cleanliness in the resuscitation trolley
4. Responsible for restocking after use as soon as possible
5. Ensure the placement of resuscitation trolley in the appropriate area
6. To ensure twice a day checks by staff who are assigned the defined task
7. To ensure all staffs awareness of the location and purpose of the resuscitation trolley.
   

What is the neonatal unit?
The neonatal unit provides expert, around-the-clock care for newborn babies who are ill or born prematurely.

NICU~Neonatal Intensive Care Unit (for the most seriously ill babies)

SCBU~Special Care Baby Unit (for babies who are not critically ill but still need complex care ie. catching up on growth and development after a premature birth, or those who are getting better after more complex treatment)

Why does my baby need to be here?
Like all newborns, premature babies have basic needs:
To be kept warm
To be given fluids and nourishment

Premature babies need extra help. For example, its harder for them to stay warm because their bodies aren't fully developed yet and they can't regulate their temperature. A special cot (an incubator) can help with this. Babies who are too small, weak or immature to feed can receive fluids and a special nutrition mixture through a drip. Or they might need a tube that carries milk into their stomachs ( through OGT- oral gastro tube feeding via syringes).

Premature babies also need extra monitoring, treatment and care because their bodies are not fully developed yet. They are vulnerable and can have serious health problems. Some of the common problems associated with premature birth are:

• Breathing problems/difficulties
• Bleeding in the brain
• Heart problems
• Gut and digestive disorder
• Eye problem ie ROP (Retinopathy of Prematurity)
• Neonatal jaundice
• Anaemia
• Infections

Who will care for my baby in the unit?

On the neonatal unit, a skilled team from different professions will care for your baby. Some of the people you may meet include:

• Staff and specialist neonatal nurses
• The senior nurse in charge of the unit (the sister or unit manager)
• Consultant paediatrician or neonatologist
• Other specialist doctors such as surgeons
• Physiotherapist
• Radiographers who take x-rays and scans
• Dieticians who advice on nutrition
• Pharmacists
• Nursery nurses
• A social worker to help you with family issues and support that might be needed after your babies goes home.

Last but not least, there's you, the parents. You know your baby best and are always her most important carers. The professionals will recognise this and treat you as part of the team. Neonatal units are open 24 hours a day for parents to visit. Others have more restricted visiting hours. Don't forget that if you're not at the hospital, you can call the neonatal unit anytime, day or night. Allways ask queations or talk to the staff about any worries you may have.

What are all those machines and tubes for?

It can be scary to see your baby attached to all sorts of machines. It can make you feel that you will never be close to her. Be reassured that as your baby gets stronger, she will need fewer machines and it will be easier for you to hold her and care for her. Some of these machines also have loud bleeping alarms and it can be frightening when they go off. Don't hesitate to ask the nurses if you don't know what an alarm means, and whether it's anything serious.

Here is some equipment you could see in a neonatal unit:

Baby warmers
Incubator: A special cot that keeps your baby warm and sometimes controls the moisture level (humidity) around her. Some incubators have lids, some don't. Some have overhead heaters.

Monitors
Vital signs monitors: Various machines might be used to keep tract of your baby's heart beat, breathing rate, blood pressure and temperature. Wires from the monitor are stuck to your baby's chest with pads (electrodes). The monitor alarms can sound off quite often.

Blood saturation monitor: This measures how much oxygen is in your baby's blood. It might be strapped to her foot or hand (sensor).

Help with breathing
Ventilator: If your baby is very premature or weak, she might need a ventilator to help her lungs do the work of breathing. This machine pushes air into the lungs, through a tube that has been passes into the windpipe.

CPAP (continous positive airway pressure): Some babies can breathe on their own with help from the CPAP machine. It gently inflates the lungs and helps keep them open. Air goes in through a mask or via tubes in your baby's nose (called a nasal cannula)

Tubes
Drips, lines and cathethers: Tubes are placed in your baby's veins to deliver fluids, medicines or nutrition. Tubes are placed in her arteries to test her blood pressure or oxygen levels (through radial line or umbilical arterial line/catheter)

Infusion pump: This machine makes sure that medicines and fluids are delivered into your baby's veins at the right rate and speed eg. 15 mls over 1 hour

Feeding (gastric) tube: Babies who are well enough to receive milk are fed through a tube into their stomach. The tube goes in through their mouth or nose.

Special lights
Phototherapy lights: Many newborns have jaundice. Their skin turns yellow because a substance called bilirubin builds up and cannot be excreted fast enough. A special light helps your baby to convert the bilirubin to a harmless substances until she can do this for herself. Your baby is placed under the lights and wears a mask to protect her eyes.

How can I help my baby while she is in the unit?

Your premature baby needs all the things that other babies need from their parents. Your touch, your voice and your presence all help a great deal. There are many things you can do to help your baby while she is in the neonatal unit:

Kangaroo care:
Once your baby is strong enough, one very good way to help her development is called kangaroo care. You simply hold your baby against your chest. Kangaroo care is soothing for your baby, and can improve her health and development.

Feed your baby:
As your baby gets stronger you can start feeding her, too. If you're keen to breastfeed let the nurses know and they should make every effort to help you with this. They should help you to express your milk in the early days before she is strong enough to breatfeed. The expressed milk will be stored and used to feed her when she is ready.
Giving your premature baby breast milk can stimulate her immune system and help her to fight illness. It's not always easy to breastfeed when your baby is premature, for all sorts of reasons, and especially when you are stressed and worried about your baby. So do make sure that you get lots of help and support.

Do the usual baby care tasks:
It may take some time, but as your baby gets stronger you can start doing all those ordinary things that most parents take for granted. like changing her nappy and giving her a bath.

Speak up for your baby:
Like all parents, sometimes you have to speak up for your child and be their advocate. If you think something is wrong, trust your instincts. Talk to the staff. Don't be afraid to ask questions, voice your worries or seek improvements.

Look after yourself:
The most important thing you can do for your baby is look after yourself. Get some sleep, eat healthy food, and take a break from it all. It's exhausting having a baby in the neonatal unit, especially if you have other children or if you're recovering from a difficult birth. It's natural to put your baby first but don't forget to be good to yourself, too.

When can my baby come home?

It's hard to say because all babies are different. It depends on their condition. Babies who are smaller and those born sooner tend to have more problems. Generally, a premature baby who is otherwise well usually stays in the neonatal unit until around the date she was due to be born (usually when the baby reached 1800 grams and the corrected age is 36 weeker). If your baby is feeding well and gaining weight with no other problems, she may be able to go home earlier than this.











Infusion

Weekend, macam kan santai saja padahal banyak kan wawa sasah n terikah baju di kulapis. Tadi bagas bawa Danish lepak sambil makan di wywy lambak ada access internet dsana. Pas tu otw balik kan kekulapis, singgah lagi ke library s'kurong, danish kan buat homework disana. Kan tanya jua siap kah sudah kad ahli wawa. Sampai sana jumpa ka kathy staff CDC...wah buat kraja clinic kah...Hmm rajin ka kathy. Rupanya mela call me several times kan bawa jalan jalan, tapi malas jua. Ntah masane malas nda mood kan jalan jalan wit frens, my good frens kan bawa jua last time, padahal kan show paper court yang ia tulung check kan....pun wawa malas. tapi kalau buka internet suka wawa, release tension. Kadang nda terasa jua bejam jam wawa dapan laptop ani. Rajin ke wywy s'kurong pasal last time kan masang broadband apa di kulapis...nda dapat access. Kan ke easiway s'kurong branch, nda tah jua ada access...boring tia jua. Adib pun sama suka melarat be facebook n begitar...biarkanlah maybe atu tah saja penghiburnya. Kadang bagi wawa sasak jua, kalau solat n study sanang jua hati wawa maliat. Wawa nda minat facebook, tapi sangat suka blogspot, jamu mata liat liat blogspot orang lain colorful n macam macam designnya....sungguh kreatif. Leka menaip, wawa cari dimana abang danish takut ia keluar....toleh danish asyik baca buku komik usulnya ...kumat kamit mulutnya tapi...oopps!..danish melimpang atas sofa library...Eeee!..danish ani baik jua nda kana tagur oleh librarian hehe. Masane wawa cuba try shopping online....siuk jua mencuci mata liat kadai kain, bakery etc. Lawa lawa sulaman n cupcake kiut miut....sampai dijadikan komersial...online shopping. Hahaha kalau baca buku Irfan Zikri pasal jutawan internet siuk jua......hmmm macam rasa kan cuba bisnes online....buang tension hehe. Kalau semua lah buat bisnes melalui online ane...alamat banyak tia tutup kadai n banyak penggangguran..adui!...dan lagi rumah pun jadi office. Bila bisnes sudah berkembang,...alahai macam durian runtuh n bernasib baik...sampai ada yang berhenti kerja, sanggup melapaskan jawatan tinggi semata mata kan fokus kapada bisnes yang jauh lebih menguntungkan. Alhamdulillah....

Hmmm biasalah namanya wad intensive care unit (NICU) plus special care baby unit (SCBU)....manang tangan, lapas satu, satu then ada lagi kraja yang teroverlap. Mesti buat yang "priority" dulu~ buat dulu yang urgent/stat. Palagi jadi nurse yang incharge stock n equipment ani awal awal pagi before 8am sudah mengorder routine wad list~ cek dulu dalam compartment setiap ubat ubat dalam trolley cukup kah inda tau jauh berkurangan. Hmmm let me recall my memory ingat ingat lupa jua tapi ubat intravenous yang selalu kana gunakan ie Calcium gluconate, potassium chloride, magnesium sulphate, dopamine, dobutamine masuk through intravenous (IV) line~ either peripheral line, long line atau umbilical venous line (UVL/UVC). Heparin goes to arterial line ataupun umbilical arterial line (UAL/UAC). kadang baby yang very ill need TPN (Total Perenteral Nutrition) usually goes through long line which is contain Lipid n Nutriflex. Common medication such antibiotics given like Netilmicin n BenzylPenicillin (crystapen). Others Aminophylline, Augmentin, Fortum, Zinacef, Flagyl, Metronidazole, Indomethiacine, Netilmicin, Phosphate sandoz, Ranitidine, Rocephine, Imipienam(Tienam), Unasyn, Atu baru treatment room, bilik untuk menyimpan ventilator n CPAP (Continous Peep Airway Pressure), ABG/CBG (arterial n capillary blood gases) machine lagi mesti di calibrate. Serum bilirubin machine lagi to analyse blood which is taken from jaundice baby yang need phototherapy. Segala pencuci n for dusting apa like hibitane n hibidil, chlorhexidine, cidex, methylated alcohol, povidone mesti jua dicek karang apa kan pencuci untuk our equipment such as ventilator/CPAP bagas bepakai, syringe pump/syringe driver, oxygen jar, ambubag, suction catheter, segala tubings, headbox, head shield, cot, incubator, resuscitaire etc. Lain lagi order sabun, lotion/cream tuk baby such as baby bath, dropolene, KY jelly, white paraffin ointment tuk moisturise baby skin yang kulitnya kering, zinc oxide cream tuk nappy rashes. Masa ani alhamdulillah, amah sudah dapat send sterilising equipment to CSSD macam inducer/airway, masks apa. Instrument yang bagas pakai like umbilical catheter set, sterile scissor, ventilator parts apa, all instruments send to MICU (Medical ICU). Daily order macam cotton, gauze, top n tail, orange stick, spatula, crepe paper, dressing pack, suture pack, suture removal set, hand towel etc pun mau jua. Eye pad mesti jua kan diantar ke Linen kan dijahit dijadikan kacamata hitam untuk menutup mata for jaundice baby kasian baby silau karang matanya masa baby on phototherapy treatment (lampu biru). Paling penting have to check every shift "Emergency Trolley" riuh karang...Masa ani emergency trolley mesti di audit supaya sentiasa always get ready beguna dimasa saat saat kecemasan. Lawa udah emergency trolley~colourful ceria jua our environment. Ada 5 drawer. Ist drawer tersimpan ubat ubat yang digunakan bila didalam keadaan critical macam Adrenaline, Metroclopromide, Heparin, Adenosine, Konakion (Vitamin K), Indomethiacine, Losec etc...Prostin disimpan dalam fridge. 2nd drawer,disimpan ETT (Endo Tracheal Tube) ada size 2, 2.5,3, 3.5, 4 according to age. Offcourse untuk premature (preterm babies) pakai size 2 or 2.5. 3th drawer tempat menyimpan laryngoscope with straight or curved blade size 0, 00 n 1, cek ada battery kah masih, plaster doudenum n white plaster to secure ETT position. Dalam drawer ani jua ada mask digunakan masa ambubagging, ada inducer/airway jua. 4th drawer, Bone marrow n Lumbar puncture (LP needle), umbilical catheter size 4 for umbilical arterial line (UAL) n size 6 for umbilical venous line or catheter (UVL). Ambubag with reservoir 600ml for preterm n 2600 for term/big baby. 5th drawer, ada disposable/sterilising gloves. hand rub, torch n scissor. Tempat nyimpan bottles 500mls line macam normal saline, heparinised saline, 50% Dextrose, water for injection etc. Ada satu trolley lagi sama jua macam emergency trolley tapi ani khas untuk drainage preparation, long line etc. Dalam fridge ada Survanta for baby yang pakai ventilator, Hapatitis vaccine, Hepatitis immunoglobulin, for eyedrops like Gentamycin eyedrop, Chloramphenicol eyedrop....eyefrop kan di apply ke mata baby prior to ROP screening macam mydriacyl n mimims. Dibilik linen, tempat menyimpan jaundice gown baby, baby blanket, Dr's sterilising gown n disposable gown apa. Pampers pakai buang, parents yang mengadakan. Tapi alhamdulillah, ada jua parents yang masani atau yang dulu anaknya di scbu mengunjuk pampers untuk baby yang ada pada masa ani...terima kasih. Pas tu masuk lagi kebilik store perkakas. Mun habis order ke medical store macam needles surflo, terumo, blades. plaster, 3 way tube, T-connector, medi swab, op-site, syringes, sterile gloves, mask, apron, suction catheter, umbilical catheter, tube feeding, ETT, ventilator set n tubings, humidifier, syring pumps n stand, trans swabs, bottle specimens, extension wire beguna banar kalau baby pakai 3 photo light banyak plug kan dipakai alum lagi masuk plug syringe pump apa. Asal keluar masuk barang saja, mesti tah dicatit dalam bin kad. Disini jua disimpan oxygen flow meter n apnoea monitor to detect any possible lung n heart problem especially in preterm babies due to immature developmental organ. Selalunya, we give them multivitamin, ferrum (iron) n folic acid even during discharge. That is why our preterm babies in paediatric still kana prescribe such medicines. As usual before discharge, baby back to mum in post natal wards or asal saja baby mencapai berat badan 1.8 kg, we give BCG immunisation (pelali), its not vaccination like flu or H1N1 vaccine. BCG selalunya ada scar because it is given sub-cutaneously (under the skin) besungkit way of injection. Atau dalam bahasa kami sampai "nampak bulan"...esok hariraya hehe. Injection given must be on the right arm side. Kalau baby begoyang tangannya, possibility site of injection kan lari, jadinya injection site temasuk kedalam, nda nampak bulan or vaccinenya tambus keluar. So that, good way in handling baby position n the correct way of injection technique is very important. Hampir 2 tahun meninggalkan scbu, wawa a bit confuse pasal dilution nya, walaupun sudah bekursus BCG tahun 2001. Bila kitani not sure, ada baiknya kitani belajar balik dari orang yang mahir dalam membagi immunisation ani. Baik jua ada geng midwife di post natal ward kan minta demo n lapas atu baru kitani membari sendiri. Palagi baibun tah tarus manainda jumpa geng. Baik jua wawa biasa banar dengan diorang ani since wawa stay dihostel masa time students. Dangan wawa bising makan sahur n liat TV sama sama. Diorang pun kadang minta tolong jua minta resite IV either untuk drip atau ubat antibiotics. Atutah sebenarnya keraja "teamwork" disini memainkan peranan. Kerjaya ani memerlukan kitani bekeraja bukan sorang tapi beramai. Apanya...muafakat membawa berkat hahaha....I like tho!

"Mengapa semua menangis?, padahal ku slalu tersenyum. Usap airmatamu, aku tak ingin ada kesedihan". Rangkap kata dalam lagu catatanku lagu melly/ba'im dalam versi mami/danish hehehe. Uh! touching banar lagu atu...mami nangis dangar lagu atu time danish inda ada. Kasih antara anak dan ibu sampai bila bila meski ada kecacatannya, ada timpangnya. Danish pernah bagitau mami supaya mami kawin sama timenya dangan danish kawin nanti. Pasal kata danish, danish ingau hati siapa dangan mami nanti kalau sudah danish kawin hahahaha cali!. Kalau danish kawin, mami sudah tua jua mana lagi ada jodoh. Sedangkan masa ani pun malas mami,...macam really really nda masa saja untuk atu.For me, satu perkara yang maha merumitkan iaitu soal hati. Alahai hati manusia boleh saja berubah dalam sekelip mata, sedangkan membinanya memerlukan masa, full commitment n.....money. Huh!, Hehe ani kan mikirkan hutang bank lagi kan disettlekan. Maybe, some other time tah, atu pun kalau ada really banar banar nice guy, insyaalah~~ Big Ooopps!!... Gunung akan ku daki, lautan kan ku seberangi...milik siapa kah hati ini??....siuk jua lah masane dangar lagu lagu jiwang melayu/inggeris tahun 80an n 90an....terkenang semasa dulu,...hatiku merasa rindu... I swear, by the moon n the sun n the star hehe. Kadang gali hati mami masa mami lagu frust tapi adib sambung lagu "bukakanlah hatimu....." hahahaha macam bercanggah saja liriknya. Alkisah last time wawa jumpa doktor tapi nurse nya tut....kisah dulu masa sekolah ugama. Mula mula malu jua tapi tepaksa jua beranikan diri pasal ia yang assess Dr. Sampat jua becerita as a fren, tanya berapa orang anak bla bla bla tapi im sure ia nda tau my situation rite now n nda mau cerita too personel. Yang wawa tekajut katanya ia masih simpan gambar sampai sekarang...Wow!!.. cayalah.. Wawa sempat tanya, baik nda ada yang berkecil hati?. Katanya dangannya pun suka maliat...buh dui!..maklum katanya gambar masa muda tapi ani berisi tia sudah hahaha!. Wawa respect orang camatu bukan macam ada yang sampai call (ntah dari mana ia tau), nda introduce siapa ia, konon misteri tah tu. Adui! zaman sekarang nda lagi camatu, atu skill lapuk, nda gentleman banar hahaha. Cukuplah setakat ani with my 2 awesome frens, bila datang uri n masalah we bincang sama sama. "sama sama gunung didaki, sama sama turun kelembah sepi, suka duka bersama dirasai...". Nah melarat tia lagi wawa ani eh,...atu lagu wawa masa kawin babu iju last month (masuk dalam carta tu!). Semalam, abang adib tanya wawa, camana boleh wawa lancar mengaji Quran?. Alhamdulillah kata wawa berkat asuhan mulah datu hjh aisyah (my beloved nini)... Datu mengajar mengaji al-Quran dikampung. Hampir semua kanak kanak dikampung atu datang kerumah belajar mengaji tiap malam sampai khatam quran...semoga rohnya dicucuri rahmat..amin. Sampai sekarang kalau tejumpa wawa, kana tagur "cucu nini aji". Alfatihah untuk nini. N now alhamdulillah ada cuzen cuzen yang aktif mengaji sampai keperingkat tinggi n mengajar mengaji jua....Fahmi (pak long) n Fikri (pak ngah). Iatah kadang bari galat rasanya kan beolah nda betantu, really love my family. Dimalam masa wawa kan bawa balik abang adib n abang danish balik kulapis dari lambak, malas wawa kan betudung pasal malam mana jua ada orang maliat. Tapi danish yang merasa kelainan, katanya "mami sudah siap kah? mami camatu saja kah inda pakai tudung?" hahaha padan muka wawa. Thanx danish, ingatkan mami..

Today first day wawa balik semula return back to scbu.Yeah, I know... ada yang tau, ada yang tekajut bagi surprise hehe...ok lah nice to hear them happy sampai nda pecaya hahahaha!....~ Yes, its me...Zur...Ka Zur!. Wah!...Teramat rindu suasana scbu nearly 2 years ninggalkan, nda yang berubah kecuali ada decoration sedikit didinding ada lampu warna warni apa. I know i love scbu very very much hati tetap pada yang satu ceewah!. Mula mula dangan college mandikan baby..hmmm rindulah pegang baby!...really love them..anugerah dan amanah tuhan yang tiada ternilainya. Ka zur,...disini kita??. Siapa itu?. Eeeh Amy anak ex-staf kami kajah nualam pun ada attachment disini. Waaah!..meriahnya scbu!. Au ah banar jua banyak my junior staf yang ampir hari menunggu hari saja lagi kan beranak hehe...macam be edar pas sorang sorang, alhamdulillah. Siuk cali liat diorang bejalan cool n pelahan saja sambil senyum senyum. Selalu jalan laju laju palagi masa time cbuk. Wah!..ada staf baru, coool!. Tibalah wawa kesuatu bilik tempat simpan ventilator machine...liat mesin ventilator/CPAP yang baru, tepaksa study dulu. Iatah yang kan wawa handle tu have to familiar wit semua equipment supaya senang macamana kan memasang tubing n humidifier nya. Mesin blood gases (ABG/CBG) n bilirubin meter brain wash lagi how to operate. Wawa soak n pasang tubing mesin SLE. Paling canggih mesin HPV yang high pressure especially for baby yang very ill. Sempat ambil barang di medical store...siuk jua kraja SE ani tapi ngaleh tejalan kesana kemari. Yup ngalih, kadang curi curi masa dangankan college buat kraja ie cucuk jelco, ready resuscitaire or cot, ambil photo light for baby kan admit dari labour room, OT labour room n some from postnatal wards. Hmmmm..kenangan dulu mengusik hati masa wawa taliat kain sarung bantal damit for sand bag yang wawa bawa suatu ketika dulu masih belum kabur warnanya. Jua bakul dikitchen tuk nyimpan piring cawan...rawan hati wawa..dulu wawa bawa didalamnya barang makanan minuman sedekah wawa selepas abang Danish lahir...sudah masuk 7 tahun tapi masih tahan!...Pas tu wawa kebilik linen atur cadar n blanket baby, lagi sekali hati wawa.... Aaaduuuh!..terlalu banyak kenangan disini. Kenangan wawa teantuk antuk bagi feeding baby masa keraja malam. Dimana wawa lepak sambil makan minum liat decorder sewaktu kerja malam wit Elo, hjh Amina, Laurie, Amy, Ajitha, Nomita n michele...really miss u all guys...Kajah nualam n ka dk salbiah (sudah pencen),yang banyak membantu semasa wawa mula mula karaja dulu. Paling wawa sebak masa wawa turun tangga dibelakang scbu, sempat wawa menoleh beranda dimana wawa senyum senyum menunduki kreta dibawah, gagas kan turun balik sewaktu dangar takbir hariraya dari masjid Omar Ali Saifuddin....OOhhh! sungguh indah kenangan atu..bilamana wawa disambut dengan senyuman ehem masa kan masuk kreta,..ah!..hilang rasa lelah wawa masa atu...abang Adib masih damit dalam kreta ketawa tawa liat wawa. Hati digamit bagai ingin sekali lagi mengulangi saat saat atu...kenangan terindah!!!. Walaumacamana pun, wawa inda kan lupa pengalaman bekerja di paediatric clinic....miss ka Teo, ka dk maidah, ka mas dangan wawa ambil barang barang...sampai ka Inah di scbu pun wawa tepanggil ka mas. kajah zainun...jangan berhenti menyanyi untuk ku hahaha.., ka sunah...thanx for ur support during my tough time hehe. Not forgetting siah,..dont cry daleng, see u some other time. We still warga RIPAS,..tak kemana, nanti jumpa jua...Kuatkan hati dan semangat..I know u can do it!. Rindu jua Dr hjh n others....tapi sempat ambil gambar gambar di paed for rememberance.