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Thu, 17 Mar 2005 10:35:41 EST |
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This is for Lucy Brey's inquiry about using D5 for "comfort" measures in a
breastfeeding baby, in particular for circumcisions. At our facility we use a
product called SweetEase which is 24% sucrose. It comes in 10 ml individual
container and our policy is that it is to be used for any procedures that may
cause pain or considered to cause pain in the newborn. These events may
include: circs, voiding cystograms, needle sticks and iv starts and other procedures
in the NICU.
The concept of dipping a pacifier in this solution and giving to baby counts
as one millimeter (ml.) per dip. It should be charted as a med. We need to
notify Mom that it is used as part of the pain management strategy for her
baby.
I also let Moms of circumcised infants where penile blocks are used it will
be used in conjunction. I advise Mom that the premise is sucking reduces
stress. I will also encourage a breastfeeding Mom that she can express colostrum
and we can "finger dip" and get a similar response. I also let Moms know that
for circed babes that the ycan anticipate that the baby may not breastfeed as
well post procedure especially where no penile block is used. I will tell Mom
that when the baby is returned to her that she should attempt to breastfeed
the baby because its the best thing she can do is to provide him with pain
relief by nursing. And to plan on during it as often as he crys after diaper
changes or anytime during the first few days. We may have Tylenol but it can be
only given so often but Mom can breastfeed on demand and provide solace
whenever.
I may have mentioned it before here we also encourage lab techs to have
breastfeeding Moms nurse during heelsticks like for the Multiple Screening Tests or
Bilirubin sticks if the baby is in the room. Most techs are now getting the
idea that we want them to do the procedure in the room so the Moms can provide
pain management. I give baby to Mom prior to Hep B vaccine for nursing
during the stick. Baby seldom if ever crys and Mom then learns she can do it when
she visits the doctor's office for either lab or immunizations.
We have printed up an announcement and hung it near the elevators promoting
one technician who embraced this and now does it routinely. ( I have caught
pedis and family members reading it and nodding approvingly.) We wrote a letter
of commendation to his file and supervisor and CEO and sent him a gift
certificate to the Latte Da cart in the lobby. We are going to use this is one of our
focuses during Breastfeeding week in the hospital so we can promote the
concept of you learned it here, NOW take it home and out into the community.
We still have a ways to go in the NICU because their babies are far more ill,
they do use SweetEase more often. They also use it when they insert the
urinary caths for voiding cystograms for us....am trying to get nurses to get more
on top of having EBM available, but since Radiology calls on short notice and
we have to go to NICU and then down to Radiology many forget to tell Mom they
are going to use pacifiers, sucrose and often a bottle. Hopefully we get
better at it.
Happy Paddy's Day!
Leanne Jewell, RNC, IBCLC, LCCE, FACCE
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