NICU - Policies, Procedures and Protocols PDF

Ministry Of Health, General Directorate Of Nursing
nd
2 Edition NICU
anual
of
ursing
olicies and
rocedures
Prepared by:
Nursing Policies and Procedures’ Committee 2011
Supervised by:
Dr. Munira Al Oseimy

General Director of Nursing-MOH
Ministry of Health, General Nursing Administration
Functions and Duties Policies and Procedures
SPECIALIZED NURSING: NEONATAL INTENSIVE CARE
TABLE OF CONTENTS
SN POLICY TITLE INDEX NUMBER

.1 ADMISSION OF AN INFANT TO NICU SNR-NICU-001
.2 ASSESSMENT OF NEWBORN SNR-NICU-002
.3 BATHING AN INFANT INSIDE THE INCUBATOR SNR-NICU-003
.4 EMPLOYEE SURVILLANCE IN NEONATAL UNIT SNR-NICU-004
.5 EYE TREATMENT OF THE NEWBORN SNR-NICU-005
.6 FEEDING THE NEWBORN SNR-NICU-006
.7 INCUBATOR CARE SNR-NICU-007
.8 INFANT WEIGHING SNR-NICU-008
.9 SKIN AND CORD CARE OF A NEWBORN INFANT SNR-NICU-009
.10 TRANFER OF AN INFANT TO OTHER FACILITY SNR-NICU-010
.11 VISITORS - TRAFFIC CONTROL IN NEONATAL UNIT SNR-NICU-011
.12 ABDOMINAL GIRTH MEASUREMENT SNR-NICU-012
.13 ARTERIAL BLOOD ANALYSIS SNR-NICU-013
WEANING OF PATIENT FROM MECHANICAL
.14 New SNR-NICU-014
VENTILATOR
.15 CHEST TUBE INSERTION, ASSISTING WITH SNR-NICU-015
.16 SURFUNCTANT ADMINISTRATION, ASSISTING WITH SNR-NICU-016
.17 BLOOD EXCHANGE TRANSFUSION SNR-NICU-017
.18 REMOVAL OF CENTRAL LINE SNR-NICU-018
.19 BLOOD TYPING AND CROSS MATCHING SNR-NICU-019
.20 UMBILICAL CATHETERIZATION SNR-NICU-020
.21 PULSE OXIMETRY SNR-NICU-021
.22 SUCTIONING SNR-NICU-022
.23 PHOTOTHERAPY SNR-NICU-023
.24 BLOOD TRANSFUSION THERAPY SNR-NICU-024
.25 PNEUMOTHORAX, NURSING CARE OF INFANTS WITH SNR-NICU-025
.26 INFANT ABDUCTION SNR-NICU-026
.27 INCUBATOR CLEANING AND MAINATENANCE SNR-NICU-027
.28 STERILIZATION PROCEDURE OF VENTILATOR TUBING SNR-NICU-028
TABLE OF CONTENTS
INDEX
SN POLICY TITLE
NUMBER
NUMBER
BABY’S IDENTIFICATION BEFORE DISCHARGE /
TRANSFER TO OTHER UNIT
.30 BLOOD DRAW FROM UMBILICAL CATHETER New SNR-NICU-030
.31 BLOOD GLUCOSE MONITORING BY HEEL STICK New SNR-NICU-031
.32 CAPILLARY BLOOD GAS (CBG) New SNR-NICU-032
.33 CARE OF PATIENTS ON MECHANICAL VENTILATION New SNR-NICU-033
.34 CENTRAL LINE MONITORING AND DRESSING New SNR-NICU-034
ASSISTING INSERTION OF CENTR AL VENOUS LINE
/PERIPHERALLYINSERTED CENTRAL CATHETER (PICC)
.36 CHEST TUBE REMOVAL- ASSESSING New SNR-NICU-036
EMERGENCY CRASH CART CHECKING AND RE-
STOCKING
.38 EQUIPMENT CHECK-UP AND TESTING New SNR-NICU-038
.39 GASTRIC ASPIRATION New SNR-NICU-039
.40 INTRAVENOUS THERAPY & CANNULATION New SNR-NICU-040
.41 ISOLATION OF THE NEWBORN New SNR-NICU-041
.42 NARCOTIC AND CONTROLLED DRUG ADMINISTRATION New SNR-NICU-042
NARCOTIC AND CONTROLLED DRUG ENDORSEMENT
AND STORAGE
.44 NASOGASTRIC FEEDING New SNR-NICU-044
.45 NASOGASTRIC TUBE INSERTION New SNR-NICU-045
NURSES CERTIFIED IN BASIC LIFE SUPPORT (BLS) &
NEONATAL RESUSCITATION PROGRAM (NRP)
NURSING CARE OF INFANT WITH HYALINE MEMBRANE
DISEASE
.48 OXYGEN THERAPY New SNR-NICU-048
.49 TRACHEOSTOMY CARE New SNR-NICU-049
.50 BREASTFEEDING, ASSISTING THE MOTHER New SNR-NICU-050
.51 AVAILABILITY OF 24 HOUR ON CALL PHYSICIAN New SNR-NICU-051
INTERNAL POLICY AND PROCEDURE

POLICY NUMBER: SNR-NICU-001 APPLIES TO: NURSING
TITLE: Admission and Discharge Criteria for Neonatal Intensive Care Unit
DPP APPROVAL DATE: EFFECTIVE DATE:
DUE FOR REVIEW: NUMBER OF PAGES 1 of 3
1.0 PURPOSE
To give appropriate monitoring and care for infants who requires continuous nursing care and
cardiopulmonary support.
To establish written guidelines for the process of triaging neonates when limited beds are available.
To establish guidelines for the assessment of neonates admitted to the Neonatal Intensive Care Unit
(NICU).
2.0 DEFINITION
None
3.0 RESPONSIBILITIES
Responsible to Head Nurse / Head of NICU Department.
4.0 POLICY
Infants requiring continuous monitoring and cardiopulmonary support are admitted in
NICU.
Admission to NICU requires a written order by the admitting physician.
Patients are prioritized by level of nursing care and acuity, need for intensive medical therapy and type of
illness.
Newborn up to 29 days old is categorized as Neonate to be admitted to NICU.
Strictly no watchers allowed in NICU.
Resuscitation equipments must be ready at all times.
Standard precaution is a must.
5.0 PROCEDURES
* ADMISSION CRITERIA:
Preterm infants with a birth weight < 1250 grams and/or < 28 weeks gestation.
Infants who have experienced difficult labor/or delivery.
Infants exhibiting moderate to severe respiratory distress or requiring assisted ventilator.
Infants with anomalies, severe congenital heart disease.
Infants who have undergone resuscitation or laryngoscopy.
NICU-1

Infants requiring hemodynamic monitoring: arterial, umbilical or central lines.

Erythroblastic infants.
Infants of diabetic mothers.
Newborn with medical problems.
Infants with possible sepsis.
Asphyxia neonatorum.
Infants requiring major surgical procedures with the potential for compromised respiratory or hemodynamic
status post-operatively, such as diaphragmatic hernia, myelomeningocele, gastroschises, omphalocele.
Any infant with whom the physician has determined that very close monitoring is needed (e.g., NEC,
SEPSIS)
* DISCHARGE CRITERIA:
Discharge of an infant may coincide with gestational age of 35 weeks and a weight of
1,600 – 1,800 grams. Small for gestational age infants may be discharged at a lower weight. Large for
gestational age infants or infants with a prolonged course of chronic lung disease may require NICU care
until the infant weighs 3,000 grams or more.
 NICU RNs will discharge infants only after the physician has written
discharge orders.
 The infant must meet the following criteria to be discharged from NICU
to home:
Ability to maintain body temperature.
Consistent weight gain.
Ability of parents / legal guardian to care for the infant.
 Parental education will be an ongoing process throughout the infant’s hospitalization.
Follow P & P on Patient’s Admission and Discharge.
6.0 ATTACHEMENTS
Nursing Assessment Sheet
Consent Form
NICU-2

7.0 MATERIALS & EQUIPMENT

None
8.0 REFERENCES
Medical Consultants Network Inc. CD
Neonatal Nursing Handbook by Carole Kenner, Judy Wright Lott
NAME: DATE
Mrs. Mary Ann Peralta

PREPARED BY:
Quality Nurse Coordinator (MCH-Jeddah) 2010
Mrs. Nada Harun
REVIEWED BY:
Central Committee Of NPP 2010
APPROVED BY:
General Directorate Of Nursing- MOH.KSA 2010
NICU-3

TITLE: Nursing Newborn Assessment

DUE FOR REVIEW: NUMBER OF PAGE: 1 of 4
1.0 PURPOSE
To identify any newborn apparent problems that needs immediate attention.
To evaluate cardiopulmonary and neurological function.
To evaluate any obvious congenital anomalies or evidence of neonatal distress.
2.0 DEFINITION
None.
Responsible to Staff Nurse.
4.0 POLICY
Upon admission, newborn will be assessed for physical health, identification of any abnormalities
that may exist, while establishing and maintaining the health and well- being of the newborn.
A thorough systematic physical assessment is an essential component in the care of a high –risk
infant.
The nurse should be aware and alert of the subtle changes and reacts promptly to implement
interventions that promote optimum functioning in the high- risk neonate.
Accurate documentation of the infant's status should be performed.
5.0 PROCEDURES RATIONALE

5.1 Complete physical and gestational age
assessment as soon as possible after delivery.
5.2 Initial assessment should include, but is not
limited to:
Estimation of gestational age by evaluation of both
neuromuscular and physical maturity.
Determination of presence of anomalies of previously
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unsuspected disease, as well

as general status of the
infant.
5.3 Assess the infant of the following:
Skin and subcutaneous tissue
Head, neck and mouth
Chest and abdomen
Genitalia and anus
Extremities, spine and joints
Respiratory status
Breath sounds
Cardiovascular system
5.4 Evaluate neurological status:
Cry
Muscle tone
Symmetry of movement
Plantar grasp
Motor reflex
Sucking and rooting reflexes
5.5 Assess for the following:
Weight documented in grams and pounds.
Length documented in centimeters and inches.
Head circumferences in centimeters and inches.
Chest circumferences in centimeters and inches.
Abdominal girth in centimeters and inches.
5.5.6 Vital signs as well as blood
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pressures, if appropriate.
Oxygen saturation
ECG strip
Intravenous line in place
5.6 Document all findings and report any unusual
findings to the physician.
6.0 ATTACHEMENTS
6.1 Neonatal Assessment and Reassessment Form.

Cardiac monitor
Gloves
Measuring tape
Stethoscope
Thermometer
Oxygen and suction equipment
Newborn assessment form
Ophthalmic antibiotic ointment
Footprint ink set
Radiant warmer, isolette or other controlled-heating device.
8.0 REFERENCES
Neonatal Nursing Handbook by C. Kenner, J. W. Cott
Neonatology Management, Procedures on Call Problem, Diseases & Drugs 5th edition by T.
Gomella
NICU-6


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-7

TITLE: Bathing an Infant Inside the Incubator

1.0 PURPOSE
To prevent heat loss and maintain perfusion to a critically ill infant.
To prevent infection and promote hygiene to a premature infant.
2.0 DEFINITION
None.
4.0 POLICY
Infants with the following clinical conditions must be given bath inside the
incubator:
With cardiac monitoring.
With oxygen and Intravenous therapy.
Preterm infant with a weight of less than 1.800 kgs.
Post-operatively.
Intravenous sites, wound site must not be immersed or soaked in water.
It is performed by an experienced nurse.

5.1 Wash hands and prepare all equipment.
5.2 Fill basin with warm water.
5.3 Check the temperature of the infant 5.3 To prevent heat loss by evaporation.
prior to bath.
5.4 Wash eyes, ears, nose and face with
clean water and cotton balls and dry
thoroughly.
5.5 Clean the body with soap & water.
Clean the skin fold, interdigital spaces
NICU-8


and the neck.

5.6 Dry thoroughly with towel.
5.7 Clean the umbilical cord with alcohol

70%.
5.8 Inspect for any discharge/ foul smell
from the umbilical cord.
5.9 Put on clean diaper and ensure it does
not cover the cord.
5.10 Wrap the infant with a blanket to 5.10 To provide extra heat when parents hold the
promote warmth. infant outside the incubator.
5.11 Document the procedure and the 5.11 For the continuity of care.
infant’s tolerance or response.
6.0 ATTACHEMENTS
6.1 Nurses' notes

Basin or infant tub
Warm water
Mild shampoo or soap
Towel
Diaper, infant clothing
8.0 REFERENCES
Photo Guide of Nursing Skills 2004, by Smith, Duell, Martin
Lippincott Manual of Nursing Practice, 7th edition by Nettina
Neonatal Nursing Handbook by Kenner, Lott
NICU-9


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-10

TITLE: Employee Surveillance in Neonatal Unit

1.0 PURPOSE
To prevent transmission of infectious disease between personnel and patient.
To prevent risk of acquiring disease from highly infected patients.
To monitor the health status of the staff who's providing care to the patient.
2.0 DEFINITION
None
Responsible to Head Nurse/ Head of Department.
Y
All staff must be free from respiratory, gastrointestinal or skin infection, active herpes simplex and
herpes zoster.
All staff must be free from infectious disease such as hepatitis.
All staff must have immunization against hepatitis, meningitis, mumps, measles, and rubella and has
known immunity to chickenpox.
If epidemic or outbreaks are confirmed all personnel staff must have culture swab of
the following areas:
Throat
Nasal
Hand
Axilla
All staff must be aware that the following infectious disease of the infant can be
transmitted to personnel.
Rubella
Hepatitis B
Cytomegalovirus
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All staff must have theoretical and clinical knowledge about infectious diseases and infection
control guidelines.
Any suspected or confirmed infectious disease must be reported to infection control nurses.
Pregnant staff must not work in NICU Isolation unit.

5.1 Restrict personnel from patient care who has 5.1 To prevent cross infection to compromise infant.
skin, respiratory, & gastrointestinal
infection.
5.2 Submit all staff for serology clearance. 5.2 Any staff found positive to any infectious disease
must not work in the unit.
5.3 Coordinate with the infection control and 5.2 Prevents cross infection.
staff clinic for the immunization of all staff
in the unit: i.e. hepatitis B vaccine,
meningitis.
5.4 Obtain multiple swabs from all staff and
personnel working in the unit once clusters
or pattern which indicates epidemic /
endemic are confirmed.
5.6 Educate the staff regarding the infectious
disease, its epidemiology, pathology, clinical
manifestation, treatment, prognosis and
prevention.
6.0 ATTACHEMENTS
None

None
8.0 REFERENCES
8.1 Neonatal Nursing Handbook by Kenner & Lott
NICU-12


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-13

TITLE: Eye Treatment of the Newborn

1.0 PURPOSE
To provide prophylaxis in the treatment of infection to the eye as in opthalmia neonatorum.
To prevent further infection.
2.0 DEFINITION
None
4.0 POLICY
All newborn infants will receive prophylaxis against opthalmia neonatorum, unless
treatment is refused by infant's parents.
The procedure is performed by a registered experience nurse in the neonatal unit.
The hands should be washed thoroughly prior to the procedure.

5.1 Place the infants in a supine position and
support the head with one hand.
5.2 Gently pull down the lower eyelid and apply
a row of ointment without touching the eyelid
with the tube.
5.3 Close the eyelid gently and allow the 5.3 To prevent spill of the medication.
ointment to coat the eye
5.4 Wipe off the excess ointment with a cotton 5.4 To prevent contamination to the contralateral eye.
ball.
5.5 Repeat the procedure with the other eye.
5.6 Observe for the following: 5.6 Report any findings to the pediatrician.
6.6.1Redness
6.6.2 Swelling
NICU-14

TITLE: Eye Treatment of the Newborn

6.6.3 Discharge
5.7 Use a new tube of ointment for each infant.
5.8 Label the tube with date and time of opening.
6.0 ATTACHEMENTS
None

Ophthalmic ointment or drops as ordered.
Cotton balls.
8.0 REFERENCES
Lippincott Manual of Nursing Practice, 7th editon by Nettina
Neonatal Nursing Handbook by Kenner, Lott.
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-15

TITLE: Feeding the Newborn (Mother’s Breast or Formula)

1.0 DEFINITION
None
2.0 PURPOSE
To provide nourishment for the baby.
To prevent dehydration.
To assist the mother in feeding her baby.
4.0 POLICY
Infants will be fed in a timely and careful manner in accordance with the physician's order.
Infants with respiration over 60 per minute shall not be nipple fed.

None

Bottle Feeding
Confirm the identity of the mother and the baby
by checking mother's ID with 3 names,
nationality, medical record number with the
baby's ID band.
Check the milk brought by the mother and the
amount.
Have the mother sit comfortably on a chair; place
the baby in the mother's arm. Assist the mother to
start feeding. Instruct when to burp and what to
do if the baby gags or chokes. Observes first
feeding.
Record the feeding and response to
NICU-16


feeding on the infant's chart as well as the

amount, if any, or regurgitation.
Feeding Baby in Nursery

Check the physician's order for the appropriate
formula to be given to the infant and obtain that
formula.
Prepare the infant for feeding by changing
diaper and wrap with blanket.
Sit in a chair holding the infant, then place the
nipple in the baby's mouth and start feeding.
Observe for sucking reflex.
Feed the baby until he/ she refuses and appears
contented. Do not overfeed and underfeed the
infant.
Burp the infant by placing a hand under the
infant's chin while in a sitting position tilting the
head forward and patting or rubbing the infant’s
back.
6.3 Breast feeding :
6.3.1 Confirm the identity of the mother and
the baby by checking mother's ID with
3 names, nationality, medical record number
with the baby's ID band.
Have the mother sit on a chair; place the baby
in the mother's arms.
Demonstrate cradle hold, football hold or side
lying position.
Assist the mother by placing the baby at
the breast and see that the baby is
latched on well and sucking before leaving
the bedside.
Instruct the mother to let the baby suck 10-15
minutes on each breast. Nursing
NICU-17


mothers should feed their infant's every 1

1/2 – 3 hours, even during the night.
6.3.6 Document the amount and tolerance to
feeding.
7.0 ATTACHEMENTS
None
8.0 REFERENCES
Neonatatology Management, Procedures on Call Problem, Diseases, and Drugs.
Neonatal Handbook by Kenner and Lott.
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-18

TITLE: Incubator Care of Infants

1.0 PURPOSE
To provide nourishment for the baby.
To prevent dehydration.
To assist the mother in feeding her baby.
2.0 DEFINITION
It is a method of providing reasonable warmth to maintain a neutral thermal environment for the
newborn, the ill and low birth weight infants.
ICY
Infants requiring heat-regulatory device are:
Preterm infants.
Low birth weight infants.
Post-operative infants.
Infants with oxygen therapy and parenteral nutrition.
Transport for high risk infants.
Birth asphyxia.
Incubators must be moved away from cold sources such as windows, air conditioning
outlet to prevent heat loss by radiation.
Newborn weighing 500 - 800 grams, range shall have the starting environmental
temperature setting of 36.5 degrees C. The neutral thermal environment for
newborn is 32.5 + 1.4 degrees C for large babies and 35.4 + 0.5 for smaller babies.
Continuous cardio-respiratory monitoring should be maintained.
All clean incubators must be pre-heated ready for use at anytime.
Temperature adjustment is according to the age and weight of the infant.
NICU-19



5.1 Wash hands and wear gloves before
receiving the infant.
5.2 Place the infant in a pre-heated incubator.
5.3 Dry the infant immediately 5.3 To prevent heat loss by evaporation.
5.4 Check the temperature by rectum.
5.5 Regulate the incubator
temperature according to the age and
5.6 Check temperature every two hourly for
newly admitted infant until stable.
5.7 Observe for thermal instability, apnea,
bradycardia, and respiratory distress.
5.8 Check the infant's temperature and wrap 5.8 To provide extra heat when parents
with blanket. hold the infant outside the incubator.
5.9 Check the infants’ behavioral changes that
reflect cold stress.
Poor sucking
Increased / decreased activity
Irritability
Lethargy
Hypotonic
Weak or inability to cry
5.10 Check serum bilirubin level. 5.10 Hypothermia can lead to increased
bilirubin level.
5.11 Inform the physician for any changes
noted in the infant.
5.12 Document the assessment of the infant prior 5.12 Serves as legal document and basis for
placement in the incubator and reassessment the continuity of care.
after.
NICU-20


6.0 ATTACHEMENTS
None

Incubator
Oxygen
Thermometer
Cardiac Monitor
Weighing scale
8.0 REFERENCES
Neonatal Nursing Handbook, by Carole Kenner and Judy Wright Lott.
Neonatology Management, Procedures on Call Problem, Diseases and Drugs 5th Edition
by Tricia Lacy Gomella.
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-21

TITLE: Weighing an Infant

1.0 PURPOSE
1.1 To have a baseline and basis for the dosage of treatment for the newborn.
2.0 DEFINITION
None
4.0 POLICY
4.1 Infant should be weighed as baseline, and body weight often provides a clue to dosage of
treatment to any disorders in the neonatal period.

5.1 Perform hand hygiene.
5.2 Confirm the identity of the infant with the
identification band with 3 names, nationality,
sex and medical record number.
5.3 Removed the pampers before obtaining the
weight of the infant.
5.4 Document in grams and pounds.
5.5 Obtain daily weight at the same time each
day and using the same scale.
5.6 The scale pan should be clean and
completely covered for each infant.
5.7 Avoid chilling the infant during weighing.
5.8 Calibration of all scales should be
monitored and adjusted on a regular basis.
5.9 Monitor for changes on weight
reassessments. If the change is greater than 50
grams variance ask another Nurse recheck the
weight.
5.10 Notify the physician for ≥10% loss of birth
NICU-22

TITLE: Weighing an Infant

weight or weight change of 50 grams or more.

5.11 Record the weight and assessment taken.
6.0 ATTACHEMENTS
Physical assessment form
Vital signs sheet

7.1 Weighing Scale
8.0 REFERENCES
Lippincott Manual in Nursing Practice 7th Edition by Nettina.
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-23

TITLE: Cord Care and Skin Care of a Newborn
1.0 PURPOSE
1.1 To reduce the incidence of peri-umbilical and skin infection.
2.0 DEFINITION
Skin is the largest organ of the body consisting of three layers, epidermis, dermis
and subcutaneous tissues. The skin of premature infants is thin and delicate
and tense to be deep red in extremely premature infant. It also appears almost
gelatinous, and bleeds and bruises easily. Postmature infant may have a peeling
patchment - like skin. Term skin is soft - wrinkled covered with vernix caseosa
and function similarly like that of adults.
4.0 POLICY
The nurse must have knowledge of the proper care and methods of preventing skin
damage.
Thorough hand washing should be done before handling an infant.
Cord care should be done with alcohol 70% daily, or as needed.
Baby powder is contraindicated because of its potential of pulmonary
contaminant.
Nursery personnel should use chlorhexidine or antiseptic soap for routine hand
washing before caring for an infant.

RATIONALE
5.1 Wash hands before receiving the infant. 5.1 To reduce the spread of microorganisms.
5.2 Receive the infant immediately under 5.2 Placing the infant in an incubator provides heat.
radiant heat source.
5.3 Establish temperature within normal range.
with lancet.
5.4 Clean the infant upon admission with sterile 5.4 To provide comfort and maintain temperature.
cotton or gauze soaked in warm water or
NICU-24

mild soap solution.).

5.5 In some instances, the infant is cleansed with 5.5 Premature infants are usually hypo-thermic and
oil to remove excessive blood or meconium. cannot tolerate bathing.
5.6 Dress the cord with alcohol 70% daily.
Follow the methods of preventing skin
damage:
To stop bleeding.
Use sterile gauze with pressure over punctured
wound.
Avoid perfumed lotion. Their skin are very fragile.
Use hypoallergenic tape for
premature babies.
Report to physician for any presence of
skin damage.
Clean excoriated buttocks with 5.7.5 Exposing to air helps heal the skin.
water and expose.
Turn the baby every 2-4 hours.
Change cardiac electrodes only
when necessary.
5.8 Document assessment and observation of the
skin and cord every shift.
6.0 ATTACHEMENTS
6.1 None

Gloves
Antiseptic Solution
Sterile Cotton or Gauze
Alcohol swab or Alcohol 70%
8.0 REFERENCES
Lippincott Manual in Nursing Practice 7th Edition by Nettina.
NICU-25

NAME: DATE
DATE

PREPARED BY:
Mrs. Naaddaa Harun
REVIEWED BY:
Central CCommittee Of NPP 2010
APPROVED BY:
NICU-26

TITLE: Transfer of Infant to Other Facility

1.0 PURPOSE
To ensure continuity of care for high risk infant.
To provide accurate and concise information to the receiving center.
2.0 DEFINITION
None
Responsible to Head nurse / Head of Neonatal Intensive Care Unit
ICY
All infants for transfer must have a written physician's order.
Parental consent must be secured prior to referral / transfer.
It is the responsibility of the Neonatologist to explain to the parents about the infant's status that needs
further intervention and specialized care.
If an infant will be transferred to other hospital, per referral by the physician in-charge, the nurse shall
confirm that:
The physician responsible to the patient has notified the receiving doctor.
Consultation referral was sent by fax and with acceptance by the receiving hospital.
Name of receiving physician with his bleep number or telephone number is written in the referral.
Medical report of patient including copies of laboratory investigations, Ultrasound / X-ray reports, MRI /
CAT scan reports, including slides to confirm the diagnosis of the patient.
Hospital Coordinator on duty will be notified to arrange ambulance diver.
The transferring nurse shall confirm the availability of emergency resuscitation equipment, medications
and oxygen needed by the patient during transport (Emergency bag for the
NICU-27


ambulance is available in Emergency Room).
A vigilant monitoring must be done during transport for the unexpected changes on infant’s status.
Stabilization of the infant must be done prior to transport, intubated if needed.
Should a medical emergency require transfer, the medical director or his deputy is empowered to organize
and complete an emergency transfer.
If an infant will transfer to private hospital as requested by the parents or family, availability of bed and
receiving doctor should be arranged by the family.
Clearance from the discharge office must be obtained by the family before transferring the patient.
All infants for transfer shall be accompanied by a physician and an experienced nurse.

5.1 Confirm the transfer order and consultation
referral with acceptance from the receiving
hospital to facilitate fast and easy transfer.
5.2 Confirm that the attending doctor explain
the reason for transfer to parents.
5.3 Transfer the infant with an ambulance
accompanied by a physician and an experienced
nurse.
5.4 Ensure portable ventilators/incubator is
working properly and Oxygen is available.
5.5 Prepare all necessary documents and
keep copies in the file.
Stabilize the infant prior to transfer:
Vital signs
Tubes, catheters must be properly secured.
Check Intravenous access and patency.
NICU-28


Documentation:
Chart time, mode of transfer, location and reason
for transfer.
Chart observation and the patient's condition at the
time of transfer.
Document latest vital signs of the patient.
5.8 Confirm the correct patient and give complete

endorsement and report of the infant to the
receiving nurse including needed documents,
present treatment and medications.
6.0 ATTACHEMENTS
Medical report
Consultation referral

Transport ventilator / incubator
Emergency bag
Oxygen cylinder
Suction machine
Ambubag with mask
Laryngoscope with blade
Cardiac monitor.
8.0 REFERENCES
Neonatal Nursing Handbook by Carole Kenner, Judy Wright Cott
Lippincott Manual in Nursing Practice 7th Edition by Nettina
NICU-29


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-30

TITLE: Visitor’s Control in Neonatal Unit

1.0 PURPOSE
To prevent unnecessary exposure to infectious diseases.
To avoid overcrowding in the unit.
To prevent possible cross-infection.
2.0 DEFINITION
None
Responsible to Head Nurse/ Head of NICU Department.
4.0 POLICY
Visitors must be limited to immediate family or guardian to control access.
People entering the unit must be limited only to personnel of the unit.
Visitors must come only during visiting time.

5.1 Explain carefully to the infant's family the 5.1 To lessen apprehension.
importance of limiting visitors inside the
unit.
5.2 Teach the family proper hand washing 5.2 To prevent transmission of
and wearing of gown. microorganisms.
5.3 Observe visiting hours. Inform security 5.3 To ensure compliance to hospital
guard for overstaying visitors. policy.
5.4 Visitors coming after visiting time should get
approval from the hospital supervisor on duty
and should be accompanied by the security
guard.
5.5 Confirm the exact and correct address and 5.5 To confirm the identity of the
telephone number in the infant's file. visitors coming to see the infant.
5.6 Inform the nursing supervisor on duty
for any event that occurred with the
visitors.
NICU-31

TITLE: Visitor’s Control in Neonatal Unit

6.0 ATTACHEMENTS
Vital signs sheet
Nurse's notes

Gown
Visitor's identification badge
8.0 REFERENCES
8.1 Medical Consultants Network Incorporated CD
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-32

TITLE: Abdominal Girth Measurement

1.0 PURPOSE
1.1 To detect significant changes in the patient's medical condition thus resulting in early
intervention.
2.0 DEFINITION
Abdominal girth measurement is a procedure to measure the abdominal circumference to
assess abdominal distention.
4.0 POLICY
Baseline measurement of abdomen should be taken to all patients observed to have abdominal distention.
Abdominal girth should be measured just above the umbilicus.
Initial site of measurement should be marked as a guide to succeeding measurement

5.1 Gather equipment and bring to bedside. 5.1 To facilitate an organize procedure.
5.2 Identify patient by Identification band, by 5.2 To ensure the identity of the patient to be
asking her name and check the medical examined.
record.
5.3 Explain procedure to the patient. 5.3 Knowledge of the procedure lessens anxiety and
promotes cooperation.
5.4 Screen patient, expose area to be measured. 5.4 To ensure privacy.
5.5 Wash hands. 5.5 To prevent spread of microorganism.
5.6 Place measuring tape under the patient's back
bringing tape around to lie directly just
above the umbilicus.
5.7 Mark skin on both sides of the measuring 5.7 To ensure consistency for succeeding
tape and instruct the patient not to remove measurements.
the marks.
NICU-33

TITLE: Abdominal Girth Measurement

5.8 Report to physician any significant changes. 5.8 To provide prompt intervention.
5.9 Document and record the date and time of 5.9 Serial measurement should be taken to
determine measuring the abdominal girth; the daily changes in girth.
measurement.
6.0 ATTACHEMENTS
6.1 Nurses notes

Patients' ID band.
Measuring Tape.
8.0 REFERENCES
Lippincott Manual of Nursing Practice, 7th Edition by Nettina
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-34

TITLE: Arterial Blood Gas Analysis

1.0 PURPOSE
To evaluate the efficiency of pulmonary gas exchange.
To assess the acid base status of the body whether alkalosis or acidosis, respiratory or metabolic in
origin and to what degree, compensated or uncompensated.
To provide important diagnostic information on:
Adequacy of gas exchange in the lungs.
Integrity of the ventilatory control system.
Blood pH and acid-base balance.
2.0 DEFINITION
Arterial blood gas analysis evaluates gas exchange in the lungs by measuring the Pa02 (partial
pressure of Oxygen) and the pH (Hydrogen ion concentration) of an arterial blood.
4.0 POLICY
A written physician's order is required.
The procedure must be explained to the patient or relative for small child.
The arterial blood gas sampling must be done by a physician, respiratory therapist or
competent nurse under aseptic technique.
Ensure the arterial blood gases (ABG) machine is functioning correctly before
obtaining sample.
Syringe used must always be flushed with heparin.
After extracting samples, air bubbles must be removed and specimen must be
placed in an iced container when transporting to laboratory.
Patient must be closely observed during and after the procedure to prevent any
complications that may arise.
NICU-35



5.1 Explain procedure to patient or to parents 5.1 To ease anxiety and encourage cooperation.
for small children
5.2 Record patient's inspired oxygen 5.2 Changes in inspired oxygen
concentration concentration alter the change in Pa02.
Degree of hypoxemia cannot be assessed
without knowing the inspired oxygen
concentration.
5.3 Take patient's temperature 5.3 Hyperthermia and hypothermia influence oxygen
release from hemoglobin.
5.4 Heparinized the 2 ml. or 1 ml. syringe if 5.4 To cast the interior of the syringe with heparin to
commercial blood gas kit is not available prevent blood from clotting.
5.5 Expel excess heparin and air bubbles from 5.5 Air in the syringe may affect measurement of the
the syringe. pH.
5.6 Wash hands thoroughly and wear gloves. 5.6 Prevents spread of infection. Gloving ensure
sterility as well as protection from exposure to blood
and body fluid.
5.7 Palpate the radial, brachial or femoral artery. 5.7 Arterial puncture is performed on areas where a
Radial artery is the preferred site of puncture for good pulse is palpable. Femoral artery should never be
ABG. the puncture site of the nurses.
5.8 Prepare chosen site with germicide. 5.8 To ensure sterility thus preventing infection.
5.9 Once the artery is punctured arterial pressure 5.9 The arterial pressure will cause the syringe
will push up the hub of the syringe and to be filled within few seconds.
pulsating blood flow will fill the syringe.
5.10 After blood is obtained, withdraw needle 5.10 Significant bleeding can occur because of
and apply firm pressure over the pressure in the artery.
punctured site with a dry sponge.
5.11 Remove air bubbles from syringe and 5.11 Immediate capping of the needles
needle. Insert needle into rubber stopper. prevents room air from mixing with
blood specimen.
5.12 Notify housekeeping department to clean 5.12 Icing the syringe will prevent a clinically
cot and room. significant loss of 0xygen
5.13 In patient's requiring serial monitoring of 5.13 All connections must be tight to
NICU-36


arterial blood an arterial catheter (connected avoid disconnection and rapid blood
to a flush solution of heparinized saline) is loss. The arterial line allow for direct
inserted into the radial or femoral artery. blood pressure monitoring in the
critically ill patient.
5.14 Blood gas analysis should be done 5.14 `Pa02 and pH can change rapidly.
immediately once sample is extracted.
5.15 Inspect the puncture site, and assess cold 5.15 Hematoma and arterial thrombosis are
hand, numbness, tingling or discoloration. complication following this procedure
5.16 Change ventilation setting of the respiratory 5.16 The Pa02 results will determine whether to
therapy equipment indicated by the results and maintain, increase or decrease the F102. The
as ordered by the doctor. PaC02 and pH results will detect if any changes
are needed in the tidal volume and rate of patient's
ventilator.
5.17 Record the time of sampling, the site of 5.17 Documentation serves as a means of
puncture, the length of time pressure was applied communication of the healthcare team for the
to control bleeding and the type and amount of continuity of treatment.
oxygen therapy the patient was receiving.
NORMAL RANGES: ARTERIAL BLOOD
1. pH 7.35 – 7.45
2. PCO2 35 – 45
3. PO2 80 – 100
4. HCO3 22 – 27 Meg/ L
5. Base Excess +2
6. Hemoglobin content 12 – 15 gm%
7. Oxyhemoglobin saturation > 95 %
VENOUS BLOOD
1. pH 7.35
2. PCO2 46 mm Hg
NICU-37


PO2 40 mm Hg
HCO3 20 m Eq/L
CLINICAL RANGE: ARTERIAL BLOOD
pH 7.30 – 7.50
PCO2 30 – 50 mm Hg
The ranges for arterial blood values given above indicate the “normal”
variation in arterial pH and PCO2. Slight variations outside these normal
ranges may not indicate a clinically changes.
The clinical ranges above indicate an acceptable pH and PCO2 from a patient
management point of view. Results outside these ranges indicate situations
requiring clinical intervention.
FOR NEWBORN:
pH 7.32 – 7.4
PCO2 33 – 40 mmHg
PO 2 60 – 80 mmHg
6.0 ATTACHEMENTS
6.1 Printed ABG Report.

Commercially available blood gas kit or:
2 or 3 ml syringe
23 or 25 gauge needle
1 ml syringe with gauge 25 or 24 needle (for children)
0.5 ml. of sodium heparin (1:1000) to heparanize the syringe
Stopper no cap
Lidocaine 1% (optional)
Sterile germicide (Povidone, isopropyl alcohol 70%)
NICU-38


Cup, plastic bag or kidney basin with crushed ice

Gloves
8.0 REFERENCES
Maternity & Children Hospital Al Musaedeiya Jeddah Policy and Procedure Manual.
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-39

TITLE: Weaning of patient from Mechanical Ventilator

1.0 PURPOSE
To provide patent airway.
To provide route for short term mechanical ventilation.
To facilitate removal of pulmonary secretions.
To relieve Carbon dioxide retention in clients with chronic pulmonary disease.
To treat acute respiratory failure.
2.0 DEFINITION
Endotracheal intubation is an insertion of flexible tube through the mouth or nose into the trachea
beyond the vocal cords that acts as an artificial airway.
4.0 POLICY
Qualified nursing personnel can assist during endotracheal intubation.
A physician written order is required.
Sterile technique must be observed throughout the procedure.

5.1 Wash hands 5.1 Maintains standard precaution.
5.2 Explain the procedure and rationale to the 5.2 To reduce anxiety and promote cooperation.
patient and parents.
5.3 Assemble all equipment. Ensure function 5.3 Patient may require ventilatory assistance during
of resuscitation bag, with mask and suction the procedure.
equipment.
5.4 Assess the patient's heart rate, level of 5.4 Provides a baseline to estimate patient tolerance of
consciousness and respiratory status. procedure.
5.5 Assemble laryngoscope. Make sure the
light bulb is tightly attached and functional.
5.6 Check tracheal cuff for leaking by inflating 5.6 Malfunction of the cuff must be ascertained before
NICU-40


cuff. tube placement.

5.7 Lubricate tube. 5.7 Aids in insertion.
5.8 Place patient in supine position with head 5.8 Proper positioning will facilitate intubation and
and neck hyper-extended and a pillow prevent complication such as necrosis of nasal septum.
under the shoulder.
5.9 Offer anesthetic spray, if time allows. 5.9 This will decrease gagging.
5.10 Oxygenate and ventilate patient before 5.10 Pre-oxygenation decreases the likelihood of
each intubation. Re-oxygenate if attempt fails. cardiac dysrhythmias or respiratory distress.
5.11 Put mark on the tube at level of patient's 5.11 Secured taping prevents tube from slipping.
mouth and tape securely.
5.12 Inflate cuff with 5 – 10 cc of air after 5.12 This will occlude the trachea.
intubation is completed.
5.13 Insert oral airway when tube is positioned 5.13 This keeps patient from biting down the tube and
orally. obstructing the airway.
5.14 Assess for expansion of both sides of the 5.14 Observation and auscultation help in
chest and presence of breath sounds. determining correct placement of tube
and that it has not slipped into the right
bronchus. Air entry should be equal.
5.15 Record distance from proximal end of tube 5.15 To detect any change in tube position later.
to the point where the tube reaches the right
place.
5.16 Secure tube to the patients face with tape 5.16 To fix the tube and prevent dislodgment of
or ETT stabilization device. inflated cuff.
5.17 Assist in chest x-ray as ordered. 5.17 To verify tube placement.
5.18 Measure with manometer. Make 5.18 The tube maybe removed or advanced
adjustment in tube placement on the basis of several centimeters for proper placement
chest X-ray results. according to chest X-ray results.
5.19 Assess Arterial Blood Gases (ABG) if 5.19 ABG ensure adequacy of ventilation and
ordered. oxygenation.
5.20 Document tube size and type, cuff 5.20 To maintain legal record and serves as a
pressure, and patient tolerance of the procedure. communication tool to other health team
members.
NICU-41


6.0 ATTACHEMENTS
Doctor's order sheet
Nurse's notes
Vital signs sheet

Laryngoscope with blade and light source. 7.7 Suction catheter
Endotracheal tube with two pressure cuff and
adapter to connect tube to ventilator or
resuscitation bag. 7.8 Suction machine
Disposable syringe (5-10cc) for cuff inflation 7.9 Stylet
Water- soluble lubricant Ventilator
Plaster, Sterile gloves Ambu bag and mask
McGill forceps Stethoscope
8.0 REFERENCES
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-42

TITLE: Chest Tube Insertion, Assisting & Maintaining

1.0 PURPOSE
To re-establish negative intra pleural pressure necessary for lung re-expansion when a
pneumothorax has developed.
To provide drainage of a pleural effusion or to obtain fluid for diagnosis.
2.0 DEFINITION
Chest tube insertion - method of inserting tube in the pleural space to facilitate evacuation of air or
fluid from the pleural cavity.
4.0 POLICY
Insertion of the chest tube should be performed by the physician under aseptic
technique, assisted by a qualified nurse.
Chest tube should be monitored for air leak and pleurovac water chamber
will be monitored for fluctuation every hour.
Rubber-tipped clamps or Kelly clamp should be ready at bedside.
5.1 Explain procedure to patients and parents of 5.1 Knowledge and understanding of the procedure
infants. alleviates anxiety.
5.2 Secure consent from patients or parents. 5.2 For legal purposes.
5.3 Wash hands thoroughly. 5.3 To prevent spread of infection.
5.4 Position the child with head of bed elevated. 5.4 Restraining the child ensures stabilization during
Secure limbs with soft restrain if necessary. the procedure.
5.5 Monitor vital signs closely. Note any 5.5 To provide a basis on which to compass the
change in skin color. Connect to cardio- patient's vital signs and evaluate status after the
respiratory monitor and oxygen source. procedure.
5.6 Set up under-water-seal-bottle following Prepares equipment to ensure readiness of the
direction on package. procedure.
5.6.1 Open saline or water container. Unwrap Establishes proper amount of water-seal
NICU-43


drainage system. Fill chambers to appropriate pressure.

level:
Place funnel in tubing or port leading to 5.6.2 Prevents spillage of water.
suction control chamber.
Pour fluid into suction control port until
designated amount is reached per doctor’s
orders, or to specific line marked on bottle,
usually indicating the 20-cm water pressure
level.
Fill water-seal chamber of drainage
system to the 2-cm level.
5.7 Put on sterile cap, mask and gown and 5.7 To ensure sterility of the procedure.
sterile gloves for both the doctor and the
nurse.
5.8 Open sterile equipment and place on 5.8 To maintain sterility and prevent contamination.
sterile surface.
The following procedure should be done by the 5.9 Prevents air from being sucked into the
physician. vein by the increasing intrathoracic
pressure.
Select the site of insertion. 5.9.1 The site of chest tube insertion should be
determined by chest x-ray films. Air collects in the
uppermost areas of the chest and fluid in the most
dependent area.
Infiltrate the area with 0.5- 1% lidocaine. Make a small
incision in the skin over rib just below the
intercostal space where the tube is inserted.
Using the tip of the hemostat, puncture the
pleura just below the rib and spread gently. Intercostal nerves, arteries and veins lie below the ribs.
This maneuver helps create a subcutaneous tunnel that
aids in closing the tract when the tube is removed.
Insert the chest tube through the opened hemostat. Be certain that the sites of the tube are within the pleural
cavity.
5.10 Following insertion of chest tube, attach to 5.10 The water-seal vacuum drainage
a water-seal vacuum drainage system. Five to ten system prevents air from being drawn
NICU-44


cm. of suction pressure is usually used. back into the pleural space.
Secure the tube with silk tape or sutures done by the 5.10 To maintain tube in proper position and
physician. prevent manipulation.
Don gloves and connects drainage system to chest tube
& suction source, if suction is indicated,
maintaining sterility of connector ends.
f changing drainage system, ask patient to take a deep
breath, hold it, and bear down slightly while
tubing is being changed quickly. 5.11.2 Prevents air influx into chest
while water seal is broken
5.12 Adjust suction flow regulator until quiet 5.12 Regulates flow of suction, not
bubbling is noted in suction control chamber. pressure; vigorous flow is unnecessary
unless large air leak is present.
5.13 Call for chest x-ray as ordered by the 5.13 To verify placement and check for
physician. residual fluid on pnuemothorax.
Positioning of the tube must always be
verified by a chest x-ray film.
5.14 Monitor vital signs every hour or as per 5.14 To evaluate patient's response
physician's order, observing for signs of to the procedure
dyspnea, restlessness, irritability and fever.
5.15 Do not elevate drainage set above level of 5.15 To prevent drained fluid from flowing
chest. back into pleural cavity.
5.16 Discard gloves and disposable materials.

5.17 Position patient for comfort, with call 5.17 Promotes comfort and safety.
button within reach.
Maintaining a Chest Tube:
5.18 Observe water-seal chamber for 5.18 Bubbling indicates air entering system
bubbling. (from patient or air leak); determines if
Suspect an air leak if bubbling is present and air is entering system through loose
patient has no known pneumothorax. Also tube connections.
suspect an air leak if bubbling is noted and
chest tube is clamped or if bubbling is excessive.
NICU-45


Check tube connections.

Every 1 to 2 hours (depending on amount of drainage
or orders):
Mark drainage in collection chamber. Detects hemorrhage or increased or decreased
drainage.
Monitor drainage system for bubbling in suction Indicates that suction is intact.
control chamber.
Check for fluctuation in water-seal Indicates patent tubing (may not
chamber with respirations. fluctuate if lung reexpanded).
5.20 If the drainage slows or stops, gently “milk” 5.20 "Milking" prevents the tubing from
the tubing in the direction of the drainage becoming obstructed from clots and
chamber as needed. fibrin. Maintaining patency of the tube
facilitates prompt expansion of the
lung and minimizes complication.
Every 2 hours: Facilitates prompt detection of problem and early
intervention.
Monitor chest tube dressing for adequacy of tape seal and
Determines air leak, hemorrhage, or tube
amount & type of soiling. obstruction & leakage at tube insertion
Assess breath sounds. site.
Indicates progress toward lung reinflation.
Monitor vital signs and temperature every Facilitates prompt detection of complications
2 to 4 hours. Use the following trouble- such as hemorrhage, tension
shooting tips in maintaining chest tube pneumothorax / hemothorax and
drainage. infection.
if drainage system is turned over & water sealPrevents
is additional air reflux & determines
disrupted, reestablish water seal & assess patient. presence of pneumothorax.
if drainage decreases suddenly, assess for tube Determines if drainage has been
obstruction (i.e., clots or kinks), & milk tubing. blocked & reestablishes tube
Check that gravity drainage systems & suction patency.
systems are below of patient’s chest. Ensures proper gravitational pull & negative water
Watch for Tension Pneumothorax & seal.
Indicates air or blood is entering chest cavity,
increasing pressure on structures in chest cavity.
NICU-46


Hemothorax
If drainage increases suddenly or becomes bright

red, take vital signs, observe respiratory status, & Retains original seal around chest tube.
notify doctor.
If a dressing becomes saturated, reinforce with Prevents air from entering chest; establishes
gauze & tape securely. temporary water seal.
If drainage system becomes broken, clamp tube
with Kelly clamp or hemostat & replace system
immediately or place end of tube in sterile bottle
of saline solution, place bottle below level of
chest, & replace drainage system immediately.
NOTE: Clamp chest tubes for no more than Air can enter pleural cavity with inspiration; if it
a few minutes (such as during system cannot escape, it will cause Tension Pneumothorax.
change).
Documentation: 5.23 To provide a comprehensive view of
the procedure and to evaluate the
effectiveness to patient's condition.
ystem function (type & amount of drainage).
Time suction was initiated or system
changed.
atient status (respiratory rate, breath sounds, pulse
oximetry, pulse, blood pressure, skin color,
temperature & mental status).
Chest dressing status & care done.
Drainage characteristics & care done.
Date & time Chest tube inserted
Name of doctor performing chest tube
insertion.
NICU-47


6.0 ATTACHEMENTS
6.1 Consent Form

Pre-packed chest tube tray typically consists of:
7.1 Sterile towels 7.11 1% lidocaine
7.2 4 x 4 gauze pad 7.12 Chest tube 8F-12F catheter
7.3 3-0 silk sutures 7.13 Sterile gloves
7.4 Curved hemostats 7.14. Mask, cap and gown
7.5A no.15 or 11 scalpel 7.15. Suction-drainage system
7.6 Scissors 7.16. Adhesive tape
7.7 25-gauge needle and 3 ml syringe 7.17. Under-water-seal bottles
7.8 Needle holder 7.18. Resuscitation equipments
7.9 Antiseptic solution 7.19. Oxygen source
7.10 Antibiotic ointment
8.0 REFERENCES
Nurses’ Guide to Clinical Procedure, 5th edition by Temple & Johnson
NAME: DATE
PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-48

TITLE: Surfactant Administration, Assisting

1.0 PURPOSE
To prevent colonization of infectious microorganisms.
To provide maximum safety to the patient using the ventilator tubing. 1.3To set
standard method of sterilization.
2.0 DEFINITION
Surfactant is a surface active agent. It is a mixture of phospholipids that
is secreted into the pulmonary alveoli and reduces the surface tension of
pulmonary fluids, thus contributing to elastic properties of pulmonary
tissues. It is administered via endotracheal tube into the infant’s trachea
as treatment of Respiratory Distress Syndrome (RDS) or Hyaline Membrane Disease (HMD).
4.0 POLICY
Surfactant therapy must be administered with written order of the physician.
The nurse should assist the physician during administration of surfactant.
Infant should be closely monitored throughout the procedure.
Strict aseptic technique should be observed during surfactant administration.
The nurse should be aware of the possible complications of the procedure.
Intubation's equipment and oxygen source must be ready for use.
Working condition of suctioning equipment must be ensured.
Crash cart must be ready in case cardiopulmonary resuscitation is needed.

5.1 Wash hands before handling the infant. 5.1 Reduces transfer of microorganisms.
5.2 Admit patient without delay. 5.2 To initiate emergency measures according
to patient’s condition.
NICU-49


5.3 Place infant in a radiant warmer and 5.3 To maintain normal body temperature
regulate temperature control accordingly. and prevent hypothermia
5.4 Attach cardiac monitor, check and record 5.4 To provide a baseline assessment.
vital signs including blood pressure and
weight.
5.5 Assist the physician in Intravenous canula 5.5 To maintain hydration, prevent
insertion and administer Intravenous fluids hypoglycemia and provides access for
as ordered. medication.
5.6 Attach the infant to pulse oximeter. 5.6 To provide continuous or intermittent non
invasive method of determining oxygen
saturation.
5.7 Assess for increase respiratory distress and 5.7 Ventilate the infant if hypoxia and
assist the physician in endotracheal respiratory distress is severe.
intubation. Connect to mechanical ventilator
and adjust setting as ordered.
5.8 Monitor Arterial Blood Gases 5.8 To determine oxygenation status and
adjust ventilator setting accordingly.
5.9 Assist in chest x-ray procedure 5.9 To determine the degree of respiratory
distress syndrome and the needs for
surfactant therapy.
5.10 Wear gloves 5.10 To facilitate sterility of procedure
5.11 Assist the physician in the administration 5.11 Survanta is a sterile non pyrogenic
of Survanta intratracheally using a 5 pulmonary surfactant. It is indicated for
inch end- hole catheter (shortened prevention and treatment of Respiratory
according to length of endotracheal tube Distress Syndrome or Hyaline Membrane
(ETT) attached to a syringe pre-filled Disease.
with the medicine.
5.12 In premature infants less than 1250 grams 5.12 As preventive treatment.
birth weight, preferably within 15
minutes after birth.
5.13 To treat infants with Respiratory Distress 5.13 As rescue dose.
Syndrome confirmed by X-ray and
requiring mechanical ventilation. Survanta
NICU-50


should be given preferably by 8 hours of

age.
5.14 Dosage and administration according to
weight of the patient.
5.15 Survanta should be inspected visually for 5.15 Survanta is off- white to light brown.
discoloration.
5.16 Survanta should be warmed before 5.16 Warm the solution by standing at room
administration. temperature for at least 20 minutes. Do
not use artificial warming method.
5.17 Suction secretions prior to administration 5.17 Secretions interfere with gas flow and
of Survanta. predispose infant to obstruction of the
passages including endotracheal tube.
5.18 Position the infant accordingly during
administration of survanta.
5.19 Increase the ventilator setting according to 5.19 To maintain appropriate oxygenation.
physician’s order during procedure.
5.20 Survanta should be administered slowly in 5.20 To prevent cyanosis and to provide
divided doses. Ventilate the infant in adequate air exchange and chest wall
between the procedure. expansion.
5.21 Monitor oxygen saturation by pulse 5.21 To provide an ongoing assessment of
oximeter during and after the procedure. oxygenation status.
5.22 Adjust ventilator setting to the usual 5.22 Once surfactant is absorbed, there is usually
parameters after the procedure as long as increase in respiratory compliance that requires
vital signs are stable. adjustment of ventilator setting to decrease Mean
Airway Pressure (MAP) and prevent over
inflation or Hyperoximia.
5.23 Check arterial blood gas at least one hour 5.23 To determine oxygenation status and to
after the procedure or as ordered. adjust ventilator settings accordingly.
5.24 Assist chest X-ray procedure at least 6 to 12 5.24 To assess patient’s response to therapy.
hours after administration of surfactant or Revising might be needed in severe
as ordered. cases of Hyaline Membrane Disease.
5.25 Suction secretions 2 to 4 hours after the 5.25 Suctioning is delayed to allow maximum
procedure. effects of the medicine.
5.26 Observe for deterioration of vital signs and 5.26 To be able to initiate immediate Intervention for
NICU-51


possible complications and refer to the any signs of deterioration

physician.
5.27 Document the patient’s condition, his vital 5.27 or continuity of care and legal purposes.
signs, the amount of surfactant
administered, date and time of
administration, and the infant’s response to
therapy.
6.0 ATTACHEMENTS
None

Gloves
Radiant Warmer
Cardiac Monitor
IV Cannula & IV Fluids
Oximeter
Mechanical Ventilator
8.0 REFERENCES
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-52

TITLE: Blood Exchange Transfusion, Assisting

1.0 PURPOSE
To prevent accumulation of bilirubin in the blood above dangerous level.
To prevent kernicterus as well as to prevent accumulation of other by products of
hemolysis from hemolytic disease.
To replace red blood cells which have poor oxygen releasing capacity and poor
carbonic anhydrase activity as in premature infants.
To remove toxic metabolites and to correct anemia.
2 DEFINITION
Exchange Transfusion is a technique or procedure used most often to maintain
serum bilirubin at levels below neurotoxicity. It refers to giving whole blood
in exchange of an infant blood. The infant's blood is repeatedly drawn out in small amount
and replaced with equal amount of compatible donor blood.
3 POLICY
Exchange transfusion procedure should be done by a physician under aseptic technique assisted by a
nurse.
Patient should be connected to cardiac monitor and pulse oximeter for continuous vital signs
monitoring throughout the procedure.
Fresh whole blood that is properly typed and cross matched should be used for exchange transfusion.
Consent from parents must be obtained by the physician.

5.1 Explain the procedure to parents. 5.1 To lessen anxiety and promote understanding
to procedure.
5.2 Confirmed that consent has been 5.2 To protect the medical team and the
obtained. institution for legal matters.
5.3 Assemble equipment making sure
sterility is maintained. Assist the
doctor in setting up blood and
NICU-53


exchange transfusion equipment.

5.4 Correct identification of the patient by 5.1 To confirm the identity.
two identifiers.
5.5 Place infant under radiant warmer and 5.5 Hypothermia increased oxygen and
keep his temperature within glucose consumption causing metabolic
thermoneutral zone. acidosis and also inhibit the binding
capacity of albumin and bilirubin and
hepatic enzymatic reaction thus, increase
risk of kernicterus. Hyperthermia
damages the donor erythrocytes elevating
the free potassium content thus predisposing the
infant to cardiac arrest.
5.6 Attach electronic cardiac monitoring 5.6 For continuous monitoring of infant's
device and pulse oximeter to infant. cardiorespiratory status.
5.7 The clinical status of the patient is
monitored and recorded before, during and
after the Procedure.
5.8 Place infant on his back. Restrain the 5.8 Proper positioning facilitates easy access to
infant during insertion of umbilical venous procedure.
line.
5.9 Infant will be kept NPO (nothing by 5.9 To evacuate the stomach and should be
mouth) for 3 - 4 hours before the procedure, left in place to prevent regurgitation and aspiration
or the stomach contents will be aspirated of gastric juices.
with a nasogastric tube (NGT) if not NPO.
Confirm the identity of the patient and the blood 5.10 The majority of fatal transfusion reactions
product by a staff nurse and a physician before are caused by clerical errors. It is strongly
initiating the procedure: recommended that two qualified individual
do the counter checking of the right patient
Name of patient and the blood product. Do not proceed with
Chart number the procedure if there is discrepancy.
Serial Number of blood Contact blood bank immediately.
Expiration date
Check blood product for clots & hemolysis.
Blood Group compatibility. All
NICU-54


information must match the medical

record and the patient.
Negative Serology report
Check donor blood for type and other identifying
data.
Blood must be as fresh as possible (never more than
3-4 days old) and must be warm as near to
body temperature as possible.
Once umbilical catheter is inserted in the umbilical

vein, a three-way or four-way stopcocks is
connected. Pre exchange laboratory
studies must be obtained for the following:
Electrolytes
Blood culture
Bilirubin
Hematocrit / CBC
Blood glucose
5.12. The physician will start exchange

transfusion under strict aseptic
technique.
Blood will be removed and replaced at aliqouts of 5
ml/kg. The removal
/infusion rates will not exceed 5
ml/kg/min.
Note and record the date and time Documentation provides information as a basis for further
exchange transfusion started stating exact management and continuity of care.
amount of successive bloodwithdrawn
with the same amount infused.
During the exchange, the blood bag must gently If blood is not agitated during the procedure, the patient’s
massaged periodically throughout the procedure hematocrit will be low at the end of the blood exchange.
to prevent settling of the red blood cells (RBC).
5.13 After each 100 ml. of blood is exchanged, 5.13 To prevent hypocalcemia since the donor blood
NICU-55


0.5 ml–1.0 ml Calcium Gluconate is has been collected Citrate Phosphate –

injected thru IV slowly. Dextrose.
5.14 Closely monitor and record vital signs 5.14 To determine possible signs of
during and after the procedure. complications as well as patient's
tolerance to procedure. If signs of
cardiac and respiratory problem is
observed, stop the procedure and
stabilized the patient.
At termination of the exchange transfusion, when the
final volume of blood is removed a portion is
placed in tubes for post exchange laboratory
studies:
Electrolytes
Calcium
Bilirubin
Hematocrit / CBC
Blood Glucose
5.16 Discard used syringes, catheters and
blood bag according to bio hazardous
waste disposal.
Documentation: 5.17 Documentation provides information
The time exchange transfusion started and as a basis for further management and
completed. continuity of care.
Vital signs.
Time, volume of blood withdrawn and infused & total
volume exchanged.
Medications given, if appropriate.
Patient's response to procedure.
6.0 ATTACHEMENTS
Blood Transfusion Consent
Blood Transfusion Request
NICU-56



Radiant Warmer
Equipment for Respiratory Support and Resuscitation
Cardiac Monitoring Device
Umbilical catheter insertion tray
Povidone-iodine solution
Exchange Transfusion Tray
Calcium Gluconate in 5-ml. Syringe
Blood Component, as ordered
Two additional 5-cc syringes 7.10Two
lavender vacutainers 7.11Two
microtainers 7.12Chemstrips
8.0 REFERENCES
Neonatal Nursing Handbook 2004, by Kenner and Lott
Hematology of Infancy and Childhood, 6th edition by Nathan, Orkin, Girsburg and Look
Medical Consultant Incorporated, CD 2002
Pediatrics & Neonatal Tests & Procedures 1996, by Taeusch, Christiansen & Buescher, Saunders
Company
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-57

TITLE: Central Line - Removal

1.0 PURPOSE
1.1 To wean patient from central venous line safely without further complications and bleeding.
2.0 DEFINITION
Central Line - Removal of central venous catheter aseptically after physician's order.
4.0 POLICY
Removal of central line should be ordered by a physician.
Central line catheter should be removed by a physician if surgically inserted and by a
trained, qualified nurse, if non-surgically inserted.
Removal of central line catheter must be done under sterile technique.

Prepare the equipment. Prevents mixing of medications.
Clamp the infusion tubing Clamping the tubing prevents the fluid from
flowing out of the catheter into the patient's bed.
Loosen tape at the catheter site while holding the Movement of the catheter can injure the
catheter firmly and applying counter traction to vein and cause discomfort. Counter
the skin. traction prevents pulling the skin
causing discomfort.
5.3 Don gloves. 5.3 To maintain sterility of the procedure.
Gloves also prevents direct contact with
the client's blood and body fluids.
5.4 Withdraw the catheter from the vein by 5.4 To avoid injury to the vein.
pulling it out along the line of the vein.
5.5 Apply firm pressure to the site using sterile 5.5 Pressure helps stop the bleeding and prevents
gauze for 2-3 minutes. hematoma formation.
5.6 Apply sterile dressing. 5.6 The dressing provides additional
NICU-58

TITLE: Central Line - Removal

pressure and covers the area in the skin

thus, preventing infection.
5.7 Discard used supplies in appropriate 5.7 To prevent spread of microorganisms.
container.
5.8 Record all relevant details of the procedure, 5.8 To provide information and continuity of care.
date and time central line is removed and
patient's response.
6.0 ATTACHEMENTS
Doctor's Notes
Nurse's Notes

Dressing set
Povidone-Iodine
Alcohol swabs
Sterile cotton balls
Sterile gloves
Sterile gauze pads
Adhesive tapes
8.0 REFERENCES
NAME: DATE
PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-59

TITLE: Cross Matching and Blood Type

1.0 PURPOSE
To prevent blood transfusion complications.
To know the patient’s blood group.
2.0 DEFINITION
Cross Matching of blood – is done to establish the compatibility between the patient’s blood and
donor.
Responsible to Staff Nurse/ Laboratory Technician.
4.0 POLICY
Laboratory technicians in blood bank should be responsible to do blood typing and
cross matching.
Any qualified registered nurse is allowed to extract blood specimen.
Specimen should be properly labeled corresponding to request forms.
Specimen should be registered in the laboratory book for proper
endorsement.
Treating doctor should complete the forms for cross matching with stamp and
signature.
Extraction of blood must be done under aseptic technique.
Blood Samples can be withdrawn from UAC/ UVC or peripheries for infants.
Proper documentation and recording is important for any amount of blood withdrawn. A total of 10 ml
withdrawn in neonate requires blood replacement.
5.0 PROCEDURES
5.1 Observe standard precaution.
5.2 Assemble things needed prior to extraction:
NICU-60


Meddab, or alcohol, sterile cotton balls.

laster,
Edta tube with label.
yringe with Gauge 21 needle or butterfly gauge 21.
Blood transfusion form and blood grouping form.
5.3 Locate site of extraction and disinfect the area.
Collect 3 ml of blood in Edta tube.(Follow P & P of Blood Specimen Collection)
Withdraw the needle gently.
Apply pressure on the site of extraction.
Disinfect site of extraction then plaster with sterile cotton ball.
5.5 If blood is withdrawn from umbilical arterial catheter (UAC) line, please refer Policy &
Procedure on how to draw blood from site.
5.6 Label the specimen with the complete data of the patient.
5.7 The treating doctor will fill up the blood transfusion form with stamp,
signature, diagnosis, amount of blood needed, date and time requested
and blood group.
5.8 Register in the laboratory book for proper endorsement.
5.9 Document the amount of blood withdrawn and record. A total of 10cc blood extracted from
infant, notify the treating doctor for replacement.
5.10 Document in the nurse's note and record the type of blood and cross match has been
performed.
6.0 ATTACHEMENTS
Cross match request
Blood group request

Meddab, or alcohol, sterile cotton balls.
Plaster,
Edta tube with label.
Syringe with Gauge 21 needle or butterfly gauge 21.
NICU-61


8.0 REFERENCES
Ministry of Health Policy & Procedure (CD)
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-62

TITLE: Umbilical Catheterization, Assisting

1.0 PURPOSE
To provide an easy access when frequent measurements of arterial blood gases are
required.
To continuously monitor arterial blood pressure.
To obtain reliable arterial access for blood sampling.
To perform exchange transfusion.
2.0 DEFINITION
Umbilical Cord contains 2 arteries and 1 vein, umbilical vein is single,
thin wall, large diameter lumen. Umbilical artery is paired with 2 thick walls,
small diameter lumen. The vessel can be catheterized in the first 4-5 days after
delivery. The catheter should be made flexible, non-toxic radiopaque material
that will not kink when advanced through a vessel and will not collapse during
blood withdrawal.
Umbilical artery catherization is a procedure wherein a catheter is inserted via
one of the umbilical artery to the premeasured desired position (usually above
the level of the diaphragm, and rest in the descending aorta).
4.0 POLICY
Procedure must be done by physician under aseptic technique assisted by a staff nurse.
The location and proper placement of the umbilical catheter must be confirmed by
X-ray.
The catheter should be filled with heparinized saline before insertion.
Patient’s vital signs should be monitored during the procedure.

5.1 Explain procedure to the parents or guardian. 5.1 Knowledge of the procedure lessens anxiety.
5.2 Place infant in supine position. Wrap a 5.2 This stabilized the patient for the
diaper around both legs to restrain the procedure and allows observation of
NICU-63


patient. the feet for vasospasm.

5.3 Put on sterile gloves, mask, cap and 5.3 To ensure sterility and prevents spread
sterile gloves (for both nurse and of infection and to protect from
physician). exposure to blood and body fluids.
5.4 Assemble equipments, making sure 5.4 To facilitate a well organized
that sterility is observed. Prepare procedure. Ensure sterility.
umbilical catheter tray by attaching the
stopcock to the blunt needle. Fill the 10-
ml syringe with heparinized saline
solution and inject through the catheter.
5.5 Clean the umbilical cord with antiseptic 5.5 To prevent infection. Observe the patient closely
solution. Place sterile drapes around the during the procedure for vasospasm in the legs or
umbilicus leaving the feet exposed. signs of distress.
Procedure must be done by the doctor:
Tie a piece of umbilical tape around the base of 5.6.1 A scalpel usually makes a cleaner cut, so that
the umbilical cord tight enough to minimize the vessels are more easily seen. There are
blood loss but loosely enough so that the usually 2 umbilical arteries and one umbilical
catheter can be passed easily through the vein.
vessel. Cut off the excess umbilical cord with
scissors or scalpel leaving 1 cm. stumps.
Using a curve hemostat grasp the end of the

umbilicus to hold upright and steady. Use
the forceps to open and dilate umbilical
artery then insert the catheter. Aspirate to
confirm blood return.
5.7 Proper placement of the catheter should be 5.7 Position above the diaphragm is at T-6, T-9 and
confirmed with abdominal x-ray. below the diaphragm at the aortic bifurcation.
5.8 Secure the catheter. Suture the silk tape to 5.8 The catheter can be fixed in place with a purse
the skin at the base of the umbilicus using string suture using silk thread and it should be
3-0 silk sutures. The umbilical stump with taped for further stability. Make sure of bridge
the catheter in place is left open. No special tape.
dressing is needed.
NICU-64


Observe for the following complications

Infection Infection can be minimized by using strict sterile
technique. Do not attempt to advance a catheter
once it has been placed and sutured into position.
Thrombosis or infarction may

Vascular accident occur. Vasospasm may lead to loss of
an extremity.
Hemorrhage may occur if the catheter or tubing

Hemorrhage becomes disconnected. If hemorrhage occurs,
blood volume replacement may be considered.
5.10 Document the time procedure started and 5.10 All facts related to the procedure
completed, the doctor who did the provides information and continuity
procedure, size of catheter inserted and of care as well as for legal purposes.
patient’s response to the procedure.
6.0 ATTACHEMENTS
Vital signs sheet
Nurse's notes

Prepackaged umbilical artery catheterization trays include:
Sterile drapes
Tape measure
Needle holder
Suture scissors
Hemostat
Forceps
Scalpel
7.9 Three way stopcock
7 .10 Umbilical artery catheter (3.5 inch for infant weighing < 1.2 kg
(5 inch for an infant weighing > 1.2 kg)
NICU-65


Umbilical tape
Silk tape
3.0 suture
Gauze pads
Antiseptic solution
Sterile gloves, mask, surgical cap and sterile gown
for physician
10 ml syringe with gauge 22 needle
Heparinized saline
8.0 REFERENCES
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-66

TITLE: Pulse Oximetry

1.0 PURPOSE
To continuously monitor oxygen saturation of arterial blood.
To assess patient's response to oxygen therapy.
2.0 DEFINITION
Pulse oximetry is a non invasive saturation monitoring where light sensor is
taped to a limb or the ear. It is useful for monitoring patient on oxygen, those
at risk for hypoxia and post operative patients.
4.0 POLICY
Calibration must be done by the Bio-medical technician.
Pulse oximeter probe must be cleaned with alcohol before and after each patient's
use.
Site of attachment of neonatal probe are the lateral side of the palm, foot and ear and the
fingers for bigger children.

5.1 Explain procedure to bigger children and to 5.1 As explanation relieves anxiety
parents for neonates. and facilitates patient cooperation.
5.2 Wash hands. 5.2 Hand washing deters the spread of microorganisms.
5.3 Select adequate site for application of the 5.3 Inadequate circulation can interfere with the Sa02
probe (lateral side of palm, foot and ear for reading.
neonate and pediatric).
Use the proper equipment. Probe should be 5.4 Inaccurate readings can result if probe or sensor is
appropriate to patient's size and age. not correctly attached.
Pulse oximeter monitor
Oximeter cable
Oximeter connector
Oximeter probe
NICU-67


5.4.5 Alcohol swab

5.5 Prepare the monitoring site by cleaning the 5.5 Skin oil, dirt & nail polish can interfere with pulse
selected area and allowing it to dry. oximetry readings.
5.6 Apply the probe securely to the skin. Make 5.6 Secure attachment and proper
sure that the light-emitting sensor and the light alignment of the light-emitting
receiving sensor are aligned opposite each and light receiving sensor to
other. promote satisfactory operation
of the equipment and accurate
recording of Sa02.
5.7 Connect the sensor probe to the pulse 5.7 Audible beep represents the
oximeter and check operation of the equipment. arterial pulse, and fluctuating
waveform indicate strength of
the pulse. A weak signal will
produce an inaccurate recording
of Sa02.
5.8 Always position the patient's hand at heart 5.8 To eliminate venous pulsation and to promote
level. accurate reading.
5.9 Set alarm on the pulse oximeter. 5.9 Alarm provides additional safeguard for patient.
5.10 Check oxygen saturation at regular 5.10 Monitoring Sa02 provides ongoing
intervals as ordered by physician. Monitor assessment of patient's condition.
patient's hemoglobin. A low hemoglobin level may be
satisfactorily saturated yet not
adequate to meet a patient's
oxygen needs.
Remove sensor on a regular basis and check Prolong pressure may lead to tissue necrosis and
for skin irritation or signs of pressure. adhesive sensor may cause skin irritation.
Relocate finger sensor at least every 4 hours, & spring Prevents tissue necrosis.
tension sensor at least every 2 hours.
Check adhesive sensors at least every shift.
Reduces risk of irritation from adhesive.
Documentation:
Date, time, type & location of sensor
Presence of pulse proximal to
NICU-68


sensor & status of capillary

refill.
Rotation of sensor & status of site.
Percentage of oxygen patient is
receiving.
6.0 ATTACHEMENTS
6.1 Nursing Assessment Form

Oximeter cable
Oximeter connector
Oximeter probe
Alcohol swab
8.0 REFERENCES
Lippincott Manual of Nursing Practice, 7th Editon by Nettina
Nurses’ Guide to Clinical Procedures, 5th edition by Temple & Johnson
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-69

TITLE: Suctioning
1.0 PURPOSE
1.1 To facilitate respiratory ventilation by removing secretions that obstruct the
airway and to prevent infection that may result from accumulated secretions.
2.0 DEFINITION
Suctioning is the aspiration of secretions, often through a rubber or polyethylene
catheter connected to a suction machine or wall outlets. It involves the
removal of secretions from the trachea or bronchi by means of a catheter
inserted through the mouth, nose, trachea, stoma, and tracheostomy or
endotracheal tube.
4.0 POLICY
Suctioning must be performed by a staff nurse with or without written order of a
Physician under aseptic technique.
Frequency of suctioning should depend on the needs of the patient.
Suction must not be applied when introducing the catheter.
Lavage fluid used for suctioning should be sterile normal saline solution.
Suction pressure should be regulated at 60-80 mmHg for neonates and 95-110
mmHg for bigger children.
Patient must be observed during and after the procedure to prevent
complications.
For adult patients dentures must be removed before suctioning

5.1 Explain to the child or to the parents that 5.1 Knowing that the procedure will
suctioning will relieve breathing difficulty and relieve breathing problems is often
NICU-70

TITLE: Suctioning
that the procedure is painless but may stimulate reassuring and ensures the patient’s
cough, gag or sneeze reflex. cooperation.
5.2 Monitor heart rate and auscultate breath Suctioning may cause:
sounds. Hypoxemia initially results in tachycardia and increase
blood pressure progressing to bradycardia,
hypotension and cyanosis.
Vagal stimulations which may results in bradycardia.
Position the patient:

Position a conscious patient in the semi- These positions facilitate the insertion of the catheter and help
fowler’s position with the head turned to one prevent aspiration of secretions.
side for oral suctioning or with the neck hyper
extended for nasal suctioning.
Position the unconscious patient in the lateral
position facing the nurse. This position allows the tongue to fall forward so that it will
not obstruct the catheter on insertion. Lateral position
also facilitates drainage of secretions from the pharynx
and prevents the possibility of aspiration.

Assemble equipments. Check function of Make sure that all equipments are functioning
suction and oxygen source. before sterile technique is instituted to
prevent interruption once the procedure
begins. Use of oxygen will help to prevent
hypoxia.
Set the desired pressure on the suction gauge To ensure that machine is working well.
and turn on the suction.
Open the sterile suction package. Set up the The sterile gloved hand maintains the sterility
cup or containers touching only its outside of the suction catheter and the unsterile glove
then pour sterile saline solution. prevents
the transmission of the microorganism to
Do a non-sterile glove on the non- dominant the nurse.
hand and then a sterile glove on the other hand,
attach the catheter to
NICU-71

TITLE: Suctioning
suction unit.
5.6 Make an appropriate measurement of the 5.6 To maintain sterility.

depth of the insertion of the catheter. Connect
the catheter directly to the suction tubing
making sure the catheter is kept in the gloved
hand.
5.7 Ventilate and oxygenate the patient 5.7 Ventilation prior to suctioning helps prevent
hypoxia.
5.8 Lubricate and introduce the catheter. Do not 5.8 This reduces friction and easier insertion.
apply suction when introducing the catheter.
5.9 Apply suction and quickly rotate the 5.9 Failure to rotate catheter may result in damage to
catheter while it is being withdrawn. tracheal mucosa. Release suction if a pulling
sensation is felt
5.10 Limit suction time to 10-15 seconds, 5.10 Suctioning for too long may cause increased or
discontinue if heart rate decrease by 20 beats decreased oxygen supply.
minute or increase by 40 beats/minute or if any
cardiac ectopy is observed.
5.11 Hyperventilate patient between suctioning 5.11 The oxygen removed by suctioning, must be
by bagging or providing oxygen. replenished before suctioning is attempted again.
5.12 Rinse catheter between suctioning. 5.12 Repeated suctioning of patient in
Continue doing suction until the airway are a short time interval predisposed
clean of accumulated secretions but no to hypoxemia as well as being tiring
more than 4 suctioning be made per and traumatic to the patient.
episode.
5.13 When secretions are removed, disconnect
suction catheter from machine tubing, turn
off suction source, and discard catheter.
5.14 Apply petroleum jelly to lips & mouth. 5.14 Prevents cracking of lips.
5.15 Dispose of or store equipment properly. 5.15 Promotes clean environment.
5.16 Position patient for comfort with head of 5.16 Promotes lung expansion.
bed elevated 45 degrees.
5.17 Discard gloves & perform hand hygiene. 5.17 Prevents spread of microorganisms.
5.18 Documentation: 5.18 To evaluate the effectiveness of the procedure and
the patient’s response
NICU-72

TITLE: Suctioning
Color, amount, & consistency of

secretions.
Changes in vital signs or patient’s tolerance to
procedure.
Character of respirations after suctioning.
Condition of mouth & oral mucous membranes.
6.0 ATTACHEMENTS
Vital signs sheet
Nurses notes

Portable or wall suction machine with tubing and collection receptacle.
Sterile container and Normal saline solution
Sterile gloves & Y-connector
Sterile suction catheter (# 8-10 French for children and # 5-8 French for infants)
Sputum trap, if specimen is to be collected
8.0 REFERENCES
Fundamentals of Nursing 7th Edition, by Kozier, Erb, Berman, Snyder
Nursing Care of Infants and Children by Whaley & Wong
Nurses’ Guide to Clinical Practice, 5th edition by Temple & Johnson
NICU-73

TITLE: Suctioning
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-74

TITLE: Phototherapy
1.0 PURPOSE
To lower bilirubin level to normal.
To prevent complications of untreated hyperbilirubinemia such as kernicterus that
leads to brain damage and even death.
To treat hyperbilirubinemia in order to prevent bilirubin encephalopathy and to reverse
the hemolytic process in any blood group incompatibility.
2.0 DEFINITION
Phototherapy- is a treatment for hyperbilirubinemia by exposing the neonate to high
intensity fluorescent light that breaks down bilirubin for transport to the GI
system and excretion in urine and feces.
4.0 POLICY
Neonates must be exposed to phototherapy with written order of physician and
according to bilirubin level.
Procedure must be explained to parents.
The infant should be exposed bare skin but eyes and genitalia are covered.
Phototherapy machine must be adjusted about 18 inches above the neonates crib or at
least 3 inches above the incubator.
Initial bilirubin level and temperature must be recorded as a baseline measurement.
Neonates must be repositioned at least every 2 hours to expose all body surfaces.
Bilirubin level should be monitored at least every 24 hours more often if levels
rise significantly.
Progress of phototherapy and infant’s response to treatment must be documented.
NICU-75

TITLE: Phototherapy

5.1 Explain the procedure to parents. 5.1 To reduce their anxiety and guilt and
to ensure cooperation.
5.2 Record the neonate’s initial bilirubin level 5.2 To establish baseline measurement.
and axillary temperature
5.3 Cover the neonate’s eyes with the 5.3 To protect the eye from light-related
opague eye mask securely enough to retinal damage and prevent reflex
stay in place, to prevent the neonate bradycardia, head molding and corneal
from opening his eyes, but loosely abrasions.
enough to ensure circulation and avoid
pressure on the eyeballs.
5.4 Clean the eyes periodically. 5.4 To assess eye circulation.
5.5 Undress the neonate to expose the skin to 5.5 Exposing the infant’s skin to
light. Remember to cover the genitalia adequate light source to achieve the
with a surgical mask. effectiveness of phototherapy.
5.6 Take the neonate’s axillary temperature 5.6 To make sure the neonate maintains
at least every 2-4 hours. normal and stable body temperature.
5.7 Check the urine specific gravity. 5.7 To gauge the neonate’s hydration status.
5.8 Monitor elimination rate, urine and stool 5.8 Phototherapy increases fluid loss through stools
amount and frequency. Weigh the neonate and evaporation.
twice daily and watch for signs of
dehydration
5.9 Clean the neonate carefully after each bowel 5.9 The loose green stool that results
movement. Don’t apply ointment on the from phototherapy can excoriate the
neonate skin. skin. Ointment can caused burns
under phototherapy lights.
5.10 Feed the neonate every 3-4 hours and offer 5.10 To ensure adequate hydration and
water between feeding. Make sure water to boost gastric motility.
intake doesn’t replace breast milk or
formula.
5.11 Take the neonate out of the crib, turn off the 5.11 To provide visual stimulation and human contact
phototherapy light and unmask his eyes at and to assess eyes for inflammation and injury
least every 8 hours if possible.
5.12 Reposition the neonate every 2 hours. 5.12 To expose all body surfaces to light
and prevent head molding and skin
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TITLE: Phototherapy
break down from pressure.

5.13 Check the bilirubin level at least every 5.13 The light may degrade bilirubin in
24 hours, more often if levels rise the blood sample and thereby produce
significantly. Turn off the phototherapy unit inaccurate test result.
before drawing venous blood for testing.
5.14 Notify the doctor if the bilirubin level nears 5.14 Bilirubin level that is too high may lead to
20 mg / dl in full term neonates or 15 mg/dl Kernicterus, brain damage or even death.
in premature neonates.
5.15 Document the progress of phototherapy 5.15 To evaluate effectiveness of care
describing changes in skin appearance and rendered. Documentation serves as
character feeding patterns and level of guidelines for continuity of care.
activity
6.0 ATTACHEMENTS
7.1 Arterial Blood Gas Result

Phototherapy Unit
Opaque eye mask
Urimeter
Prepackaged eye coverings if available
Photometer
Thermometer
Surgical face mask and small diaper
8.0 REFERENCES
NICU-77

TITLE: Phototherapy
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-78

TITLE: Blood Transfusion Therapy

1.0 PURPOSE
To restore intravascular volume after hemorrhage.
To restore the oxygen-carrying capacity of blood by replacing red blood cells.
To replace clotting factor and correction of anemia.
2.0 DEFINITION
Blood transfusion therapy is the intravenous administration of whole or blood component for
therapeutic purposes.
ICY
Blood transfusion must have a written physician’s orders for type, amount, and rate of
blood administration.
Consent for blood transfusion must be signed by patient or parents for children.
Standard precautions are to be followed when handling blood product.
Blood for transfusion must be cross matched to the recipient’s blood type, and two qualified
staff nurses should verify the patient’s identity prior to blood extraction for type and cross
match.
Blood must be counterchecked by the Doctor and the attending Nurse, once Blood is
obtained from the blood bank.
Before giving blood transfusion two nurses should identify the patient correctly using the
appropriate means of identification such as using medical record number, identification
bracelet, and patient’s name.
Blood transfusion must be checked at patient’s bedside by two registered nurses or a
registered nurse and a physician before infusion.
Name of patient
Chart number
Serial Number on the Blood bag level
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Expiration date
Blood Group compatibility
Serology – free results or negative results
Baseline vital signs should be taken and recorded.
A standard blood filter must be used and to be changed after 8 hours.
Nurse should observe patient closely for the first 5 to 15 minutes after the blood transfusion
is initiated.
The blood transfusion is to begin slowly within 30 minutes after obtaining the blood from
the blood bank and should be infused within 2 to 3 hours but not more than 4 hours.
Blood transfusion should be stopped and physician should be notified immediately if
signs of blood transfusion reaction occur.
Medication should never be injected into an Intravenous line with the blood component
because of the risk of contaminating the blood product with bacteria.

5.1 Verify a written doctor's order for Blood 5.1 A written order requesting the blood
Transfusion. transfusion therapy must be made by a
physician prior to implementation of this
procedure.
Assess the patient for the following:
History of blood reaction To determine patient's history of blood

reaction.
Check blood return for venous access. Verify patency of canula.
Obtain vital signs and document. Vital signs is important to provide

baseline data for any transfusion
reaction
5.3 Check that transfusion consent has been 5.3 Patient consent must be obtained or parent
properly signed and explain to the patient. consent for children.
NICU-80


5.4 Explain procedure to patient and family if 5.4 To allay anxiety and obtain cooperation
present, particularly the need for frequent from patient.
vital sign checks.
5.5 Pre medicate the patient as per doctor' order, 5.5 To prevent infusion reaction.
15 to 30 minutes before transfusion.
(Optional)
Obtain blood product by registered nurse from
blood bank & check the following with a
doctor:
Serial Number of blood
Expiration date
Blood Group
Negative Serology Reports
Check blood product for clots & hemolysis
Confirm the identity of the patient and the blood 5.7 This is to make sure blood is given correctly to the
product by two staff nurses, or a staff nurse and a right patient.
physician before initiating the blood
Name of patient.
Chart number.
Serial Number of blood
Expiration date
Blood Group compatibility. All information must
match the medical record and the patient.
Negative Serology report
Check blood product for clots &
hemolysis
5.8 Wash hands and wear disposable gloves. 5.8 Reduce transmission of microorganism.
Prevent the nurse from direct contact to
patient’s blood and body fluid.
5.9 Prime the blood administration set with 5.9 Blood products are compatible only
Normal Saline, ensure that it flush through with Normal Saline. Flushing prevents
the IV tubing to clear air bubbles (optional infusion of air and potential air
for adult). embolism.
NICU-81


5.10 Invert blood component bag gently 2 to 3 5.10 Equally distribute cell throughout preservatives
times solution.
5.11 Spike the product bag using aseptic 5.11Opening of clamp will prime the tubing with
technique with clamp close. Squeeze drip Normal Saline. Priming the tubing remove air from the
chamber, allowing saline to cover the filter. system.
5.12 Close the clamp on the Normal Saline and 5.12 Prevent back flow of blood into the
open the clamp on the blood. Allow the blood to Normal Saline.
completely cover the filter.
5.13 Remain with patient during the first 5 to 5.13 Signs and symptoms of adverse
15minutes after initiating the blood transfusion. reaction usually occur during the first
15 to 30 minutes.
5.14 If no signs of reaction for the first 15 5.14 Maintaining the prescribed rate of flow
minutes, regulate the flow rate according to decreases risk of fluid volume excess
Physician’s order to run at least 2 to 4 hours while restoring vascular volume.
(drop factor of BT is 10 drops/ml).
5.15 Monitor vital signs according to blood 5.15 Frequent monitoring of vital signs will
transfusion observation sheet. help the nurse to alert quickly to any
transfusion reaction.
5.16 Observe for chills, flushing, dyspnea, rash
or other signs of transfusion reaction.
Stop blood transfusion immediately for any adverse 5.17 Prompt intervention may minimize
hemolytic reaction. potential for serious complications
Assess the patient
Prioritize your nursing intervention
according to your assessment.
Inform the doctor
Inform the CN/HN/Supervisor
Write an Incident report
5.18 Flush the IV tubing with Normal Saline 5.18 Infuse IV saline solution to keep IV
and discard the blood bag according to bio- line patent for supportive measures in
hazardous waste disposal, when transfusion is case of a delayed transfusion reaction
completed.
5.19 Document in the nurse’s notes:
5.19.1 Date & time blood started &
NICU-82


consume
Amount & Type of blood infused
nitial & subsequent vital signs & the response of the
patient.
IV canula size, location & condition of
Intravenous (IV) site.
nstructions given & pt’s understanding of
instructions.
BLOOD TRANSFUSION:
The transfusion of blood and blood products remains a highly effective and
potentially life saving treatment for many patients. However, blood transfusion
rom one individual to another is risky; significant among these risks is the
potential for human error and subsequent transfusion of the incorrect blood
component.
Blood Samples to be obtained for Acute Blood Reaction:
1. Blood sample to examine serum for hemoglobin and confirm RBC group
and type.
2. Anticoagulated blood sample for a direct Coomb’s test to determine the
presence of antibody on the RBCs.
3. The first voided urine sample to test for hemoglobinuria.
Blood Components:
A. Platelet – consist of platelets suspended in Plasma.
Infused 20-60 mins; depending on total volume, 1 unit of platelet / 10 kgs.
of body weight.
Indications include prevention or resolution of hemorrhage in patients with
thrombocytopenia or platelet dysfunction.
B. Plasma (Fresh or Fresh Frozen)

Consist of water (91%), plasma proteins including essential clotting factors
(7%), and carbohydrates (2%).
Infusion can be completed within 15-30 mins., depending on the total volume.
NICU-83


Indications include treatment of blood loss or blood clotting disorders related

to liver disease and failure. DIC ( Disseminated Intravascular Coagulation ),
over anticoagulation with warfarin, congenital or acquired clotting factor deficiencies
C. Cryoprecipitate – consist of certain clotting factors suspended in 10-20 ml plasma. Each unit
contains 80-120 units of factor VIII (antihemophilic and von Willebrand factors), 250 mg
fibrinogen, and 20% -30% of the factor XIII present in a unit of whole blood.
Indications include correction of deficiencies of factor VIII
(ex. Hemophilia A and von Willebrand disease),factor VIII, and
fibrinogen ( ex. DIC).
Dosage : Adult dosage is 10 units, which may be repeated every 8-12 hours
until the deficiency is corrected.
6.0 ATTACHEMENTS
Consent for Blood Transfusion
Blood Transfusion request
Nurses' notes
Vital signs sheet

Gloves.
Syringes.
IV tube.
Cannula.
Blood transfusion tube.
Normal saline.
8.0 REFERENCES
Maternity & Children Hospital Al Musaedeiya Jeddah Policy and Procedure Manual.
NICU-84


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-85

TITLE: Nursing Care of Infants with Pneumothorax

1.0 PURPOSE
To be able to evacuate / drain accumulated air or fluid in the pleural space by insertion of chest tube.
To provide effective breathing pattern and promote effective gas exchange.
2.0 DEFINITION
Pneumothorax is the presence of air in the pleural space occurring spontaneously or from trauma.
Pneumothorax is classified as follows:
Spontaneous pneumothorax – sudden onset of air in the pleural space with deflation of the
affected lung in the absence of trauma.
Open pneumothorax – an opening in the chest wall large enough to allow air
to pass freely in and out of thoracic cavity with each attempted
respiration.
Tension pneumothorax - build up of air under pressure in the pleural space resulting in
interference with filling of both the heart and lungs.
4.0 POLICY
The staff nurse must have knowledge about pneumothorax.
The nurse must be alert to assess for signs and symptoms of pneumothorax.
Equipments for needle aspiration and chest tube insertion should be ready in case needed.
Policy and procedure in the care of patient with chest tube should be followed.
Standard precaution should be observed.
Equipment for intubation and oxygen therapy should be ready at bedside.
Crash cart should always be ready in case cardiopulmonary resuscitation is needed.
NICU-86



5.1 Wash hands before and after handling the 5.1 To maintain standard precaution.
infant.
5.2 Admit patient without delay. 5.2 To initiate emergency measures according to
patient's condition.
5.3 Place infant in a radiant warmer and 5.3 To maintain body temperature within accepted
regulate the temperature control as thermal range.
needed.
5.4 Attach to cardiac monitor. Check and 5.4 To provide a baseline assessment.
record vital signs including blood pressure
and weight.
5.5 Insert cannula and administer Intravenous 5.5 To maintain hydration and also to
fluid solutions as ordered. provide access for medications.
5.6 Monitor pulse oximetry & Arterial blood 5.6 To provide continuous or intermittent non invasive
gas. method of determining oxygen saturation.
5.7 Provide oxygen as needed. 5.7 To resolve impaired gas exchange.
5.8 Assess for increase respiratory distress, 5.8 To determine the severity of respiratory distress is
cyanosis and desaturation, apnea and nasal severe.
flaring.
5.9 Assist the physician in endotracheal 5.9 Ventilate the infant if hypoxia and respiratory
intubation and attach to mechanical distress is severe.
ventilator as ordered.
5.10 Suction secretions as needed. 5.10 To maintain patency of airway. Frequent
suctioning may cause bronchospasm, hypoxia and
bradycardia due to vagal nerve stimulation.
5.11 Auscultate chest for diminished breath 5.11 Presence of air in the pleural space prevents the
sound and percuss for hyper resonance. lung from expanding, making it difficult for the
Observe for chest asymmetry. infant to inspire resulting to atelectasis.
5.12 Note for abdominal distention. 5.12 The infant's abdomen will become distended
because of pressure on the diaphragm.
5.13 Assist in chest x-ray procedure as 5.13 To confirm presence of air in the pleural space.
ordered by the physician.
5.14 Assist the physician in needle aspiration 5.14 This serves as emergency measure until chest
to release air in the pleural space. tube can be inserted.
NICU-87


5.15 Prepare equipments for chest tube 5.15 Insertion of chest tube into the pleural space
insertion and assist the physician in the through a small chest incision to evacuate trapped air
procedure. in order to achieve re-expansion of collapsed lung.
5.16 Implement care for patient with chest tube
(refer to chest tube policy and procedure).
5.17 Continuously monitor vital signs including 5.17 To provide assessment of progress or
blood pressure and oxygen saturation. complication.
5.18 Perform cardiopulmonary resuscitation if 5.18 To prevent cardio respiratory arrest.
needed.
5.19 After pneumothorax has been drained, 5.19 To check for recurrence of pneumothorax.
evaluate patient's condition, vital signs,
repeat chest x-ray as ordered.
5.20 Check ABG as ordered and regulate 5.20 Arterial blood gas (ABG) indicates changes in
oxygen therapy accordingly. respiratory status. It also provides information
regarding lung function, lung adequacy and
tissue perfusion.
5.21 Document complete information on 5.21 The effectiveness of nursing intervention is
patient's condition and the patient's determined by continuous reassessment and evaluation
response to interventions rendered. of care.
6.0 ATTACHEMENTS
6.1 Arterial Blood Gas Result

Radiant warmer
Oxygen source
Intubation equipment
Cardiac monitor
Equipment for Chest tube insertion
Gloves
Suction equipment
Mechanical ventilator
NICU-88


8.0 REFERENCES
Fundamentals of Nursing 7th Edition by Kozier, Erb, Berman, Synder
Neonatology Management, Procedures on Call Problem, Diseases and Drugs 5th Edition by Tricia Lacy
Gomella
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-89

TITLE: Infant Abduction

1.0 PURPOSE
To provide safe and secure environment for babies who are unable to protect themselves.
To locate and reunite the infant safely with the family as quickly as possible.
2.0 DEFINITION
None
Responsible to Staff Nurse/ Security guard.
4.0 POLICY
Nurses should observed strict adherence to a newborn identification system.
Matched Identification band must be presented to Nursery staff, when mother goes to
Nursery for breastfeeding or other members of the family will visit the
infant, if any doubt, staff should accompany the baby to the mother’s room to confirm.
Mothers should be instructed to release the baby after breastfeeding to staff wearing
appropriate identification.
Babies should only be transferred to other department per bassinet or crib. Anyone
CARRYING a baby in the hallway should be inspected. The staff should question any
visitor not wearing an Identification badge.
During visiting time Nursery door should be monitored and locked, an authorized
staff will always be present.
If an infant is missing and abduction has been confirmed, "CODE PINK" should be
announced and simultaneously staff and security shall respond to their responsibilities.
5.0 PROCEDURES
5.1 If the infant cannot be found in the mother’s room or the Nursery, and the nurse has suspicion that
infant is missing, inform your Head nurse immediately.
5.1.1 Staff will check every room in the unit.
NICU-90

TITLE: Infant Abduction

Simultaneously the following actions will follow:

All available hospital personnel will respond to all exits.
Communication to the Head of Security and Head of the Department.
a. Security staff should stop the flow of traffic going out of the
hospital until proper authorities will arrive.
b. Security staff will search around the hospital.
5.3 Once the abduction has been confirmed, the attending physician should notify
the parents.
5.4 All staff on duty when the abduction occurred will remain in the unit until authorities completed
proper questioning.
5.5 Document the incident from the discovery of the abduction until infant is located. Incident
report/Occurrence Variance Report should be accomplished.
6.0 ATTACHEMENTS
6.1 Occurrence Variance Report Form

None
8.0 REFERENCES
Ministry of Health Policy and Procedure, (CD)
NAME: DATE
PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY: General Directorate Of Nursing- MOH.KSA 2010
NICU-91
POLICY NUMBER: SNR-NICU-027 NURSING

APPLIES TO:
Incubator Cleaning and Maintenance

DPP
TITLE:
APPROVAL DATE: EFFECTIVE DATE:
1.0 PURPOSE
To prevent colonization of microorganisms.
To provide maximum safety to patient using the incubator.
2.0 DEFINITION
None
4.0 POLICY
Incubator must be changed every 7 days for terminal cleaning with soap and water
before disinfecting with final touch solution.
Terminal cleaning must be done when changing the incubator and upon patient’s
discharge.
Date when incubator was changed should be recorded.
Incubator hood should be cleaned daily with hexamide a concentration of 10 ml in 1
liter of water according to infection control protocol.
Spills must be removed as they occur.

5.1 Switch off incubator 5.1 To prevent electric hazard.
5.2 Remove linen and other items inside
Incubator.
5.2.1 Remove all fittings. 5.2.1 Must be cleaned separately.
5.3 Using cleaned cloth, wash both outside
and inside of the incubator thoroughly
with Final Touch Solution (Quadri-
Ammonia) as supplied by Infection
Control Department.
5.3.1 Empty excess water from water 5.3.1Contaminated water is a good
NICU-92

APPLIES TO:

DPP
TITLE:
receptacle (Humidifier). breeding place for bacteria.

Do not start cleaning until the incubator is
empty and disassembled. Remove all solid
waste and contaminants from disassembled
parts.
Do not use products that contain
alcohol. 5.3.2 Alcohol can cause crazing of the clear hood and
Do not expose the hood assembly to other plastic parts.
direct radiation from germicidal lamps. Ultraviolet radiation from these sources can cause
The controller module should be removed to cracking of gaskets and crazing of the hood.
prevent accidental wetting. Remove the power
cord from the wall outlet and all probes from the The controller heater can be hot
side panel. enough to cause burn. Wait for 45
minutes after the power has been
turned off before removing the
controller from the incubator base.
5.4 Check the temperature by rectum.
5.5 Regulate the incubator
temperature according to the age and
weight.temperature every two hourly for
5.6 Check
newly admitted infant until stable.
5.7 Observe for thermal instability, apnea,
bradycardia, and respiratory distress.
5.8 Check the infant's temperature and wrap 5.8 To provide extra heat when parents
with blanket. hold the infant outside the incubator.
5.9 Check the infants’ behavioral changes that
reflect cold stress.
Poor sucking
Increased / decreased activity
Irritability
Lethargy
Hypotonic
Weak or inability to cry
NICU-93

APPLIES TO:

DPP
TITLE:
5.10 Check serum bilirubin level. 5.10 Hypothermia can lead to increased
bilirubin level.
5.11 Inform the physician for any changes
noted in the infant.
5.12 Document the assessment of the infant prior 5.12 Serves as legal document and basis for
placement in the incubator and reassessment the continuity of care.
after.
6.0 ATTACHEMENTS
None

Gloves
Disinfectant solution
Wash basin
Clean cloth
8.0 REFERENCES
Manufacture’s Guidelines
Infection Control Guidelines by Dr. Wafa Trazi.
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-94

TITLE: Sterilization Procedure of Ventilator Tubing

1.0 PURPOSE
To prevent colonization of infectious microorganisms.
To provide maximum safety to the patient using the ventilator tubing.
To set standard method of sterilization.
2.0 DEFINITION
Sterilization is the process of destruction of live microorganisms leaving no viable
forms including spores.
Responsible to Head Nurse/ Staff Nurse.
4.0 POLICY
Ventilator tubing must be changed twice weekly.
Ventilator tubing and humidifiers must be soaked with disinfectant solution hexamide 30 ml in 1 liter water
according to infection control protocol for 4-6 hours for non infected cases and 24 hours for infected cases.
Ventilator tubing must be rinsed and dried thoroughly before packing in the autoclave bag.
Packed tubing must be sent to CSSD for sterilization.
Flow sensor must be soaked in enzymatic cleaner solution – 0.2 ml in 25 ml water according to
manufacturer’s recommendation.

5.1 Check tubing of ventilator 5.1 Ventilator have different types of
tubing.
5.2 Separate tubing according to types of 5.2 Put label not to mix up together.
ventilator.
5.3 Prepare soaking solution- Hexamide 30 ml
in 1 liter of water according to infection control
protocol.
NICU-95


5.4 Wash tubing in running water before

soaking.
5.5 Soak for 4-6 hours for non infected
cases and 24 hours for infected cases.
Don’t mix infected and non
infected tubing.
Don’t soak or rinse bacteria filters.
5.6 Rinse and dry thoroughly ventilator 5.6 To Moist tubing is a perfect breeding
tubing. area for bacteria.
5.7 Pack ventilator tubing in autoclave bag.
5.7.1 Label the autoclave bag, write
the name of department and
the date of sending to CSSD.
5.8 Enter in the CSSD logbook and send for
sterilization.
6.0 ATTACHEMENTS
6.1 CSSD Logbook

Gloves
Container for soaking
Soaking solution
Enzymatic cleaner solution
Autoclave bag
Dryer
8.0 REFERENCES
Manufacturer’s Guidelines,
Infection Control Manual by Dr. Wafa Trazi
NICU-96


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-97

TITLE: Baby’s Identification before Discharge / Transfer to Other Unit

1.0 PURPOSE
To prepare safe discharge from the hospital with correct identity of the baby.
To provide appropriate Health education, counseling of parents, explanation of home medication,
importance of breastfeeding and out patient appointment.
2.0 DEFINITION
None
Responsible to Head Nurse/ Staff Nurse.
ICY
Baby can only be discharged or transferred after the Pediatrician has written order.
If the mother of the baby still in the hospital, the infant should be transferred or discharged to the mother
after discharge clearance is presented by the father. The nurse assigned to the baby and if available a
nurse fluent in Arabic or a Saudi staff
in Neonatal Intensive Care Unit (NICU) will transfer or discharge the baby to the
mother in the OB/Gyne ward. Transferring nurse and the receiving nurse must confirm
matching identity of the mother and infant by checking both identification band with mother’s
3 full name, nationality, medical record number, and sex of the baby. Date and time of delivery
and other personal data including mother and baby’s blood group must coincide with both
medical records. Ask the mother to sign the neonatal discharge paper with the presence of the
nurse handling the baby’s mother. Both nurses will sign the discharge paper. Baby’s care must
be dual responsibility of the mother and the nurse assigned to the baby’s mother until both will
be discharged.
4.3. On the discharge of both mother and baby from the hospital, the nurse must check
the baby’s data on the bracelet compared to mother’s medical record and bracelet
in front of the mother, with the presence of CN or HN, Resident on Duty (ROD)
and the father of the baby or a relative with the discharge clearance. ID band after
confirmation should be removed and attached to the file.
If the mother is not in the hospital, the infant is allowed to go home only after discharge clearance is
presented by parents, and two nurses must confirm the
NICU-98


identity of the infant with the correct family.

Health Education, home medication, baby’s care, including breastfeeding must be instructed to mother.
Parents and family should be instructed about the safe use of medical equipment if
the baby has any.
Confirmed if the baby received first dose of immunization before discharge, vaccination card should be
given to parents with instructions when to comeback
for the second dose.
Baby’s discharge date, time, condition and with whom must be documented in the nurses’ notes.
Name & signature of the assigned nurse & the nurse who witness the identification of the
patient must be legible on the discharge form, & the signature of the father.
The baby should be properly covered when attending to his/her physical needs.

5.1 Confirmed discharge or transfer order by
Pediatrician written in the baby’s file and
discharge summary.
5.2 Inform the parents of the baby’s discharge, if
the mother is not admitted in the Hospital.
Prepare Neonatal discharge form and check for
completion of the following documents:
Discharge Summary
mmunization Card
Out Patient prescription and medication
Appointment card
Referral if needed.
5.4 Inform parents to obtain discharge clearance
from the discharge office.
5.5 Once discharge clearance is obtained, dressed
up the baby, assigned nurse will confirm with
another nurse the identity by checking baby’s
NICU-99


data (3 names, nationality, medical record number

and sex of the baby) on the bracelet compared to
mother’s medical record and bracelet with the
presence of the father of the baby or a member of
the family.
5.6 Hand over the necessary documents to the
parents including medications and follow up
appointment.
5.7 Ask the father to sign the Neonatal discharge
form, countersigned by the assigned nurse & the
nurse who witnessed baby’s identification.
5.8 Provide Health Education to mother regarding
baby’s care and importance of breastfeeding.
5.9 Document in the nurses’ notes date, time,
condition and with whom the baby is
discharged.
the mother still in the ward, transfer or discharge the baby
to the mother:
Discharge clearance must be obtained by the father before
transferring the baby to the mother.
Confirm the location of the mother and inform the nurse of
the receiving ward that infant is for transfer or
discharge.
Transferring nurse will transport the baby in a crib or
bassinet.
The nurse will endorse the infant to the nurse in charge of
the mother at the bedside, both nurses will confirm
the correct identity of both mother & the baby (by
checking matching mother & infant’s Identification
band with mother’s 3 names, nationality, medical
record number & sex).
Transferring nurse will endorse everything about the baby
(condition, medication,
NICU-100


immunization, feeding, etc.) to both mother

and the receiving nurse.
5.11 Once the baby left, note the discharge of the
baby in the logbook, including date & time.
5.12 Notify housekeeping department to clean cot
and room.
5.13 Disinfect and prepare cot for new patient.
6.0 ATTACHEMENTS
Discharge Summary
Vaccination Card
Out Patient prescription
Appointment Card
Neonatal Assessment Form

Cot.
ID Band.
8.0 REFERENCES
8.1 Medical Consultants Network Incorporated CD
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-101

TITLE: Blood Draw from Umbilical Catheter

1.0 PURPOSE
To facilitate easy access of blood extraction.
To provide important diagnostic information.
2.0 DEFINITION
Collection of blood specimen aseptically from the umbilical catheter.
4.0 POLICY
A written physician’s order is required.
Aseptic technique must be observed.
Patency of the umbilical catheter must be maintained.

5.1 Wash hands thoroughly, put on gloves 5.1 To prevent spread of infection. Gloving ensure
sterility as well as protection from exposure to
blood and body fluids.
5.2 Open heparinized saline. If not available, 5.2 To prevent blood clotting.
heparinized a 3 ml syringe with 0.05 ml
of 1000 units per ml heparin. Eject
remaining heparin from syringe.
5.3 Place sterile gauze under stopcock of 5.3 To prevent spillage of blood.
umbilical catheter.
5.4 Insert non-heparinized 3ml syringe into 5.1 To prevent mixing of blood with IV fluid and
stopcock. Turn off the stopcock to ensure good result of desired laboratory
connected to IV flow. investigations.
5.5 Withdraw 2 ml of blood to be placed on
sterile field and turn stopcock halfway to
keep the tubing clear.
5.6 Insert another syringe into the stopcock.
Withdraw desired amount of blood.
NICU-102


5.7 Remove syringe from stopcock, turn

stopcock halfway off to patient.
5.8 Put extracted blood into the desired
specimen container.
5.9 Return 2 ml blood through line, clearing
all air from syringe and stopcock and
return stopcock to upright position, flush
line, replace with new syringe.
5.10 Label sample with patient’s information. 5.10 All facts related to the procedure should be
Record the time and amount of blood documented accordingly, to provide
taken and patient’s response to the information about the patient’s tolerance to the
procedure. procedure.
6.0 ATTACHEMENTS
6.1 Laboratory request

Alcohol swabs
1 ml syringe
Heparinized saline
3 ml syringe
Sterile gauze
Heparin 1000 units per ml
Gloves
Specimen container
8.0 REFERENCES
Medical Consultant Network Inc. CD
Fundamentals of Nursing 7th Edition by Kozier, Erb, Berman and Synder
Neonatal Nursing Handbook 2004, by Kenner and Lott
NICU-103


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-104

TITLE: Blood Glucose Monitoring by Heel Stick

1.0 PURPOSE
To evaluate episodes of hyperglycemia and hypoglycemia in order to determine appropriate treatment.
To evaluate effectiveness of medications.
2.0 DEFINITION
Measuring of blood sugar with the use of a blood glucose machine extracted from the medial
aspect of the heel of an infant.
3.0 POLICY
A written physician’s order is required.
The procedures must be done by a qualified nurse.
Standard precaution must be applied. Blood contaminated items should be disposed according to infection
control policy.
Meter calibration of the glucometer must be validated and confirmed before use.
If alcohol is used to cleanse the site of puncture, the first drop of blood must be discarded.

5.1 Determine safe area to use for neonatal 5.1 This area is “marked’ by a line extending
th th
heel stick posterior from a point between the 4 and 5
toes and running parallel to the lateral aspect of
heel, and a line extending posterior from the
middle of great toe running parallel to medial
aspect of heel.
5.2 Place infant in supine position for foot to 5.2 To improve blood flow.
hang lower than torso.
5.3 Wipe the heel to be lanced with alcohol 5.3 To cleanse and remove microorganism that is
swab. Dry thoroughly. present in the site of puncture.
5.4 Turn on the glucometer; validate proper 5.4 Errors in glucose reading can result in
calibration with the strips to be used. miscallibrated of improperly coded meters.
NICU-105


5.5 Check for the glucometer readiness for

testing blood glucose.
5.6 Prick the patient’s heel lateral avoiding 5.6 Avoid pricking the most sensitive area.
the plantar surface.
5.7 Apply the blood carefully to the strip test
area.
5.8 Cover the lance heel with gauze until
bleeding subsides.
Complete the test 5.9.1 Blood contact time with the test strip
The blood remains on the strips as the vary with each glucometer, precise
glucometer process the result. timing is crucial for accurate result.
Meter with a “wipe” system require that the
blood be wiped off from the test ball at the
appropriate end time. The strip is inserted into
the meter final reading.
5.10 Document reading and patient’s
response to procedure.
6.0 ATTACHEMENTS
6.1 Diabetic sheet

Gluco meter
Test strip
Lancet/Lancing device
Alcohol swab
Disposable gloves
2 x 2 gauze
Cotton ball
8.0 REFERENCES
Neonatal Nursing Handbook by Kenner and Cott.
Fundamentals of Nursing 7th Edition by Kozier, Erb, Berman and Synder.
NICU-106


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-107

TITLE: Capillary Blood Gas (CBG)

1.0 PURPOSE
1.1 To check blood gas for patient's level of oxygenation.
2.0 DEFINITION
Capillary blood gasses will be obtained to assess adequacy of oxygenation and ventilation to infants who
do not have arterial line access, per physician’s order.
3.0 POLICY
Physician’s written order is a must.
Standard precaution must be observed.

5.1 Identify the patient using two (2) patient identifiers.
5.2 Warm heel of the infant for 10 to 15 minutes prior to
procedure.
5.3 Cleanse site (lateral and medial posterior surface
only) with alcohol and pierce with lancet.
5.4 Collect blood in capillary tube making sure that no
air bubbles present. Obtain a continuous flow to
avoid clotting. Cap ends and place in ice or do the
Blood gas analysis as soon as possible (ASAP).
5.5 Apply pressure and Band-Aid.
5.6 Obtain results and refer to physician.
5.7 Documentation:
5.1.1 Date and time test drawn, person
obtaining sample and site of obtained
specimen.
5.6.2 Infant’s response to procedure and
notification of results to physician.
NICU-108

TITLE: Capillary Blood Gas (CBG)

6.0 ATTACHEMENTS
None

Alcohol swabs
Betadine swabs
Heparinized capillary tubes with caps, as needed
Band-Aid
Gloves
Lancet
8.0 REFERENCES
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-109

TITLE: Care of Patients on Mechanical Ventilation

1.0 PURPOSE
To achieve and maintain normal gas exchange.
To prevent atelectasis.
To prevent complications from oxygen toxicity.
To maintain physiologic functioning in patient with:
Respiratory failure
Neurovascular disease
Muscular skeletal disorders like flair chest.
Pulmonary disorders like adult respiratory distress syndrome.
To maintain cardio pulmonary functioning in cardiopulmonary arrest.
To maintain acid-base balance.
2.0 DEFINITION
Mechanical ventilator functions as a substitute for the bellows action of the thoracic cage and diaphragm.
Mechanical ventilation is indicated to maintain safe levels of oxygen or carbon dioxide by spontaneous
breathing even with the assistance of other oxygen delivery systems.
4.0 POLICY
Before connecting patient to mechanical ventilator, there must be a written order from the physician.
Ventilator parameter must be written by the physician or an anesthetist
Ventilator alarm must be set within the limits and checked for correct function. Never turn off alarms.
Ventilator parameter must be set up by a respiratory therapist or a qualified nurse with minimum 1
years' experience in Intensive Care Unit (ICU).
Patient requiring mechanical ventilation must be admitted in ICU.
Ventilated patients must be cared by a qualified nurse.
NICU-110



5.1 Wash hand. 5.1 Maintains standard precautions.
5.2 Check for the written order of the doctor.
Arrange the equipment:
uction setup & suction catheters
Oxygen source
tethoscope
Ambu bag (bag-valve mask)
gloves
oximetry
5.4 Explain the procedure to the patient and/or 5.4 The patient or his family should be
his family. aware of the importance of putting the
patient on mechanical ventilation, at the
same time prepare them psychologically
for weaning.
5.5 Secure airway. Make sure cuffed 5.5 A closed system between the ventilator
endotracheal or tracheostomy tube (depends on and the patient lower airway is necessary
doctor’s preference) are in place. for positive pressure ventilator.
Assess oxygenation status by doing the Determines efficacy of ventilation; helps
following: identify problems that may require quick
Auscultate breath sounds. intervention or changes in ventilator settings.
Note rate & depth of respirations.
Assess level of consciousness (LOC).
Note any cardiac dysrhythmias. Identifies problems due to decrease cardiac perfusion.
Indicates possible displacement of endotracheal tube
Note symmetrical chest wall movement. (ETT).
5.7 Continuously monitor oxygen saturation with 5.7 Ensures that changes in oxygen saturation will be
pulse oximetry. quickly identified.
Prepare the ventilator:
et up desired circuitry
Connect oxygen and compressed air
NICU-111


source
Turn on power.
et tidal volume = usually 10-15 ml/kg body weight 5.8.5 This is adjusted according to pH (hydrogen ion
(BW) or peak pressure. concentration of arterial blood) and PaC02
(partial pressure of carbon dioxide).
Set oxygen concentration:
et ventilator sensitivity.
et rate at 12 to 14 breaths per min. (can change 5.9.2 This setting approximates normal ventilation.
according to patient condition and response and
the type of ventilator being used.)
5.10 Connect the patient's airway to the 5.10 This will prevent tubing from dislodging the
ventilator tubing. Make sure all connections are artificial airway.
secure.
5.11 Assess patient for adequate chest movement 5.11 This will ensure proper functioning of
& rate of respiration. Note peak airway pressure equipment. Gas flow is adjusted to
and positive end expiratory pressure (PEEP). provide safe I: E ratio.
Adjust gas flow if necessary
Set airway pressure alarms according to Appropriate interventions maybe necessary.
patient's baseline:
An alarm sounds if airway pressure selected is
High air way is set at about 20 cm. H20 above
peak airway pressure. exceeded, indicating decreased lung
compliance, decreased lung volume,
increased airway resistance or lose of
patency of airway.
Alarm activation indicates
inability to build up airway pressure
Low airway pressure is set at 5-10 cm. to because of disconnection or leak, or
H20 below peak airway pressure. inability to build up airway pressure
because of insufficient gas flow to
meet patient's inspiratory needs.
5.13 Assess frequently change in respiratory

status If change is noted, notify attending
NICU-112


physician.
5.14 Ensure adequate ventilation at all times 5.14 The patient ventilation & oxygenation is the
monitor and trouble shoot alarm conditions. priority and should not be compromised.
However, if it cannot be corrected
immediately removed the patient from
mechanical ventilation and manually ventilate
with resuscitation bag.
5.15 Turn patient from side to side every 5.15 This will increase lung compliance and improve
1&1/2 to 2 hours, or more frequently as oxygenation.
possible.
5.16 Do passive range of motion exercises of 5.16 This may improve circulation.
all extremities.
5.17 Assess for need of suctioning every two 5.17 Patient on mechanical ventilation are
hours unable to clear secretions on their own.
Suctioning helps to clear secretions and
stimulate cough reflex.
5.18 Assess breath sounds and airway patency 5.18 It confirms ventilatory distribution and
every 2 hours. proper placement of the Endotracheal or
tracheostomy tube.
5.19 Assess lips and tongue for pressure 5.19 Reduces risk of skin breakdown and allows for
ulcers and provide oral care. early intervention.
5.20 Rotate tube placement from side to side 5.20 Decreases pressure on lips and mouth Tissues &
of the mouth. reduces risk of ulceration.
5.21 Check water level in the humidification 5.21 Water condensing in the inspiratory
reservoir. Empty the water that condenses in the tubing may cause increased resistance
delivery and exhalation tubing into a separate to gas flow this may result in increased
receptacle not into the humidifier. Always wash peak airway pressure. Warm, moist
hands after emptying fluid from ventilator tubing is a perfect breeding area for
circuitry. bacteria. If this water is allowed to
enter the humidifier, bacteria maybe
aerosolized into the lungs. Emptying
the tubing also prevents introduction of
water into the patient's airways.
NICU-113


5.22 Measure delivered tidal volume and

analyzes oxygen concentration every 4 hours
or more frequently if indicated.
5.23 Obtain accurate daily weight and precise 5.23 Positive fluid balance resulting
monitoring of intake and output. increase in body weight and interstitial
pulmonary edema is a frequent problem.
Ventilation stimulates release of
antidiuretic hormone, resulting in
decreased urine output. Prevention
requires early recognition of fluid
accumulation.
5.24 Administer sedation as needed per 5.24 Synchronizes respirations and reduce
doctor’s order. workload of breathing. Reduces the risk
of patient “fighting” the ventilator.
5.25 Monitor nutritional status & 5.25 Mechanically ventilated patients are at risk for
gastrointestinal function. development of stress ulcers.
5.26 Provide psychological support. 5.26 Mechanical ventilation may result in sleep
Communicate to patient even without deprivation and loss of touch with surroundings
response and ensure that the patient has and reality.
adequate rest and sleep.
5.27 Change ventilator circuitry every 24 5.27 Prevents contamination of lower airways.
hours, assess ventilator function every 4
hours.
5.28 Maintain a flow sheet to record 5.28 Established means of assessing effectiveness and
ventilation patterns such as Arterial Blood progress of treatment
Gas result, blood investigation &
assessment of patient condition.
Document in the nurse's notes: 5.29 Provide legal record & communication to other
Type of ventilator used members of the heath team.
Ventilator settings, alarms on
Date & time mechanical ventilator started.
Any problem with the ventilator and
actions taken.
Observation and patient's tolerance
NICU-114


6.0 ATTACHEMENTS
6.1 ABG result

Suction setup & suction catheters
Oxygen source
Stethoscope
Ambu bag (bag-valve mask)
Clean gloves
Pulse oximetry
8.0 REFERENCES
Photo Guide of Nursing Skills by Smith, Duell, Martin
Neonatal Nursing by Kenner and Lott.
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-115

TITLE: Central Line Monitoring and Dressing

1.0 PURPOSE
1.1 To provide an aseptic, systemic approach in changing a central line dressing to prevent infection at the
Intravenous (IV) site and the introduction of microorganisms into the blood stream.
2.0 DEFINITION
Central Line Dressing - care given by a qualified nurse on the site of the central venous line.
Responsible to Staff Nurse/ Physician.
4.0 POLICY
Registered nurse may change a central line dressing and monitor the patency of the
catheter.
Handling central line and change dressing must be under strict aseptic technique.
Central line dressing should be changed every 48 hours.
Monitoring & Performing Maintenance
5.1 Wash hands thoroughly. 5.1 To prevent spread of microorganism.
5.2 Label each lumen of multilumen catheter 5.2 Prevents mixing of medications.
with name of fluid / medication infusing.
Flush lumens without continuous fluid 5.3 Prevents obstruction of catheter lumen
infusions and capped every 8 hours with with blood clot.
heparin solution (usually 1:100 dilution) or
normal solution.
Depending on length of tubing and size of 5.3.1 Minimize leakage via cap or damage
catheter, use 1 to 3 mL of flush solution. to catheter; prevents rupture of PICC
Use 6 mL or ordered amount of flush for tubing due to excess syringe pressure.
Hickmann catheter & short small needle (25
gauge).
For PICC lines, use a 10-cc syringe or larger for
flushing.
NICU-116


5.4 Flush tubing between infusion of 5.4 Prevents medication interaction or lumen
medications and drawing of blood, first obstruction.
using saline and then Heparinized solution.
5.5 Always aspirate before infusing medications 5.5 Ensures patency of line ad validates
or flushing. presence in vessel.
5.6 Monitor for clot formation in lumen. If 5.6 Reduces risk of embolism; prevents
resistance is met when flushing tubing, do dislodging of clot.
not force. Aspirate and remove clot if
possible; if not, notify physiccian.
5.7 Monitor respirations and breath sounds 5.7 Promotes early detection of fluid entering
every 4 hours. chest cavity or pulmonary embolism.
5.8 Maintain IV fluids above heart level. Do not 5.8 Prevents blood reflux into tubing;
allow fluid to run out, and air to enter tubing. prevents infusion of air, which could result in air
embolism.
Tubing Change
5.9 Prepare fluid and tubing aseptically. 5.9 Minimizes exposure to microorganisms
5.10 Don mask & sterile gloves. 5.10 Protects against contamination.
5.11 Expose catheter hub or rubber port of 5.11 Precedes connection of tubing
multilumen catheter.
For centrally inserted lines: 5.12 Increases intrathoracic pressure; prevents
Ask patient to gently turn head to opposite side, air from entering vein; reduces risk of air
take a deep breath, andbear down (Valsava’s entering lumen.
maneuver).
Disconnect old tubing and quickly connect new
one.
Open fluid and adjust to appropriate infusion rate.
5.13 Remove gloves, discard equipment, and 5.13 Reduces risk of infection transmission.
position patient comfortably.
Dressing Change
5.14 Explain procedure to patient. 5.14 Gains cooperation.
5.15 Perform hand hygiene and gather 5.15 Reduces microorganism transfer and
equipment. promotes efficiency.
5.16 Prepare equipment/supplies on sterile 5.16 To facilitate access of supplies and
field. prevents contamination of catheter site.
NICU-117


5.17 Don clean gloves and mask. 5.17 Decreases the risk of contact with blood
and secretions.
5.18 Place a towel under the Intravenous site. 5.18 This prevents soiling of bed linens.
5.19 Assess IV site for presence of infiltration or 5.19 Inflammation and infiltration
inflammation. necessitates removal of the catheter to
avoid further trauma to the tissues.
5.20 Remove previous dressing & discard the 5.20 Reduces risk of infection transmission.
used materials in the appropriate
container.
5.21 Remove the tape securing the catheter 5.21 This prevents in advertent dislodgement
by stabilizing catheter hub with one hand. of the catheter.
5.22 Don sterile gloves. 5.22 Prevents site contamination.
5.23 Beginning at catheter insertion site and 5.23 Antiseptics reduce the number of
wiping outward to the surrounding skin, microorganisms present at the site thus,
clean insertion site with alcohol three reducing the risk of infection
times, allow it to dry, then clean with
antiseptic agent.
5.24 Cover gauze with tape or transparent 5.24 Secures dressing; prevents pull on
dressing; wrap tubing on top and cover catheter.
tubing with tape.
5.25 Label and secure the dressing. Write date, 5.25 Determines time for next dressing
time and initials on top of the dressing. (usually dressing requires every 48-72
hours), and as needed.
5.26 Raise side rails & position patient for 5.26 Promotes patient safety & comfort.
comfort.
Documentation: 5.27 To provide information pertaining to

Date & time of catheter insertion. procedure, patient's tolerance and
Type & location of catheter, Including the number condition, and the nursing intervention
of linens. for the continuity of care.
Appearance of insertion site.
Care & monitoring done, including
flushing & resistance if any.
NICU-118


6.0 ATTACHEMENTS
Doctor's Order Sheet.
Nurses notes
Intravenous tag

Mask, Gown, Sterile Gloves
Dressing Set
Alcohol swabs
Povidone – Iodine Solution
Sterile Gloves
Benzoin
Sterile Cotton Tipped Applicator
Sterile Gauze
Adhesive Tapes
8.0 REFERENCES
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-119

TITLE: Assisting Insertion of Central Venous Line / Peripherally

Inserted Central Catheter (PICC)
1.0 PURPOSE
1.1 To provide a better access to the central venous system for patients with chronic illness who require
long term Intravenous therapy, to prevent trauma and complication of multiple venipunctures.
2.0 DEFINITION
Central Venous Line - is a catheter surgically or non-surgically inserted through a major vein, such
as the subclavian vein or less commonly, the jugular vein.
4.0 POLICY
Only a physician competent in this procedure shall insert a central line assisted by a nurse.
Procedure must be done under strict aseptic technique.
Heart rate, blood pressure, respiration shall be monitored throughout the procedure.
Central line placement shall be verified by X-ray after insertion.

5.1 Wash hands thoroughly. 5.1 To prevent the spread of microorganisms.
Assemble all equipment’s needed. 5.2 To facilitate patient care by ensuring all the
Central Line Catheter Set equipment available.
Antiseptic Solutions
10-cc Syringes ( 3 pcs. ) 5 cc syringe (2pcs.) and
Needles
Lidocaine 1%
Sterile Gloves
Administration Set, Tubings,
Adaptors
3-0 Silk Suture, scalpel
NICU-120


Needle holder and Sterile scissors

3 way stopcock (3pcs.)
Gown, Mask, Cap for Personnel involved in the

procedure.
Normal Saline 10 ml
Heparin flush Solution
Sterile gauze
Transparent occlusive dressing
5.3 A full explanation of the procedure should 5.3 Obtain patient’s consent to ensure
be given to the patient. cooperation and allay anxiety.
5.4 If the catheter is inserted through subclavian 5.4 To increase venous filling and reduce risk
or internal jugular vein, place patient in a head of air embolism.
down position (Tendelenburg). If patient has
respiratory distress, place in supine position
with feet elevated 45 to 60 degrees (modified
Trendelenburg’s).
5.5 For PICC insertion, position the arm for ease 5.5 Facilitates access to insertion site.
of access to the upper arm or antecubital vein
sites-basilic or cephalic-with arm extended at
45- to 60-degree angle from the body.
5.6 Hold patient’s hand; obtain assistant & 5.6 Prevents disruption of procedure or contamination
restrain both hands if patient is resistant or of sterile field.
confused.
5.7 Don face mask & apply mask to patient 5.7 Reduces risk of insertion site contamination.
(optional).
5.8 Inform patient of progression of the 5.8 Prepares patient for discomfort; helps to
procedure, particularly when needle stick is to decreases startle reaction.
occur.
5.9 After the vein has been punctured and the 5.9 Prevents air from being sucked into the
physician has removed the syringe from the vein by the increasing intrathoracic
insertion needle and inserted a guide wire pressure.
through the needle (central line), instruct the
patient to take a deep breathe and to bear down
NICU-121


(Valsava’s maneuver) while the guide wire is

inserted.
5.10 As the multilumen central catheter or a 5.10 Indicates the presence of the catheter in
PICC is inserted over the guidewire into the the vein and removes air from the
vein is withdrawn, observe for blood backing catheter tubing before infusion of fluid.
up into the catheter lumen. Aseptically aspirate
air from the lumen and then flush saline
through each catheter lumen.
5.11 Apply IV lock and cap to catheter lumen, if 5.11 Maintains sterility of lumen and
needed. establishes a close system to minimize
blood loss & air entry.
5.12 Once the catheter is in place & sutured, 5.12 Protects IV site from air leak, debris, and
apply sterile gauze or transparent dressing and, organism while allowing visualization of
if needed tape dressing down securely. catheter tubing & insertion site.
5.13 Label dressing with time and date of
catheter insertion.
5.14 Assist portable Chest X-ray per physician's 5.14 Verifies correct placement and position
order, then begin regular infusion rate after of the catheter tip (vena cava or right
catheter position has been confirmed. atrium) before large amount of fluid are
infused.
Observe for complication: The potential risks of the procedure make it
important to closely monitor the patient
following insertion of CVP.
Potential risk of pneumothorax and
hemothorax.
Observe respiratory rate and pattern at least Signs and symptoms of pneumothorax do not
every half-hour together with blood pressure always appear suddenly. Progressive
and pulse. dyspnea and deterioration of cardiovascular
status maybe a presenting symptoms.
Permits the diaphragm to drop & aids chest
Sit the patient upright in bed supporting with expansion.
pillows. Enable adequate arterial oxygen.
Give oxygen in high concentration.
5.16 Haematoma over insertion site.
NICU-122


Apply pressure dressing to insertion site. Prevent extension of haematoma and staunch
blood flow.
Observe for signs of extending May indicate internal hemorrhage.
haematoma.
Documentation: 5.17 To provide information and continuity of care.
ate & time performed
ame of the physician
ite of insertion
atient’s response to procedure.
6.0 ATTACHEMENTS
Intravenous Fluid (IVF) Tag
IVF sheet

Central Line Catheter Set
Antiseptic Solutions
10-cc Syringes ( 3 pcs. ) 5 cc syringe (2pcs.) and Needles
Lidocaine 1%
Sterile Gloves
Administration Set, Tubings, Adaptors
3-0 Silk Suture, scalpel
Needle holder and Sterile scissors
3 way stopcock (3pcs.)
Gown, Mask, Cap for Personnel involved in the procedure.
Normal Saline 10 ml
Heparin flush Solution
Sterile gauze
Transparent occlusive dressing
8.0 REFERENCES
Nurses’ Guide to Clinical Procedure, 5th edition by Temple & Johnson
NICU-123


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-124

TITLE: Chest Tube Removal- Assessing

1.0 PURPOSE
1.1 To ensure safe and consistent practice in the removal of chest tube by a physician
assisted by staff nurse.
2.0 DEFINITION
Chest tube removal - is a procedure wherein tube inserted in the pleural space is being removed
after re-expansion of the lungs has been attained.
5.0 PROCEDURES
4.0 POLICY RATIONALE
5.1
Chest tube must be removed upon physician's order.5.1 Knowledge and understanding of the procedure
Explain the procedure to the patient or to
parents for small children. lessens anxiety and promotes cooperation.
ThisAdminister
5.2 is a two person procedure;
prescribed removal offor
pre-medication tube must
5.2beTodone by the
relieve physician
pain, and aby patient during the
experienced
nurse.
pain 30 minutes before procedure. procedure.
5.3
If more than one tube is inserted, the appropriate tube to befacilitate
Assemble all equipment at bedside. 5.3 To removedsystematic procedure.
must be identified by the physician
5.4 Wash hands and wear gloves.
according to chest x-ray film. 5.4 To prevent infection. Gloves protect the nurse
from contamination to blood and body fluids.
Chest
5.5 tube must
Prepare be clamped
dressing several
to be placed hours
in the before removal.
chest 5.5 To facilitate readiness of the procedure.
tube site after removal.
Strict aseptic technique must be observed.
5.6 Remove chest tube dressing. Leave sternal
incision dressing intact.
NICU-125


5.7 The physician cuts the suture from the 5.7 To facilitate easy removal of the chest tube.
skin and removes the remaining anchoring
suture.
5.8 The physician quickly pulls out the chest 5.8 This is done either during the patient's
tube. expiration or at the end of a full
inspiration to prevent air from being
sucked back into the pleural space while
tube is being pulled out.
Place Vaseline gauze and 4 x 4 gauze pad into To prevent adherence of the dry gauze to the
site. wound site that may cause irritation.
Apply dressing to the wound site and secure To prevent wound from infections.
with adhesive tape.
Have chest x-ray done after removal of the chest tube.
To confirm that the whole tube was removed and to check
Discard all supplies including chest tube and for any possible complications.
drainage bottle in a biohazardous garbage bag. Proper disposal of wastes facilitates the
prevention of cross contamination.
5.10 Observe patient for signs of respiratory 5.10 Notify the physician immediately for
distress caused by loss of negative intrapleural any complication that may arise after
pressure or tension pneumothorax. removal of the chest tube, for immediate
management.
5.11 Document all information about the
procedure, and patient's response.
6.0 ATTACHEMENTS
Nurse's notes
Sterile gauze 4 x 4
Vaseline gauze
Povidone-iodine solution
Scalpel
Adhesive tape
Chest tube clamps
Biohazard garbage bag
Gloves
NICU-126


8.0 REFERENCES
Fundamentals of Nursing 7th Edition, by Kozier, Erb, Berman, Snyder
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-127

TITLE: Emergency Crash Cart Checking and Re-Stocking

1.0 PURPOSE
Pharmaceutical care department with CPR (Cardiac pulmonary and resuscitation) committee are
responsible to determine the items containing mobile crash cart, the pharmacist maintaining the expiry
date and replacement to all unit in the hospital.
To provide easy checking and re-stocking of crash cart
2.0 DEFINITION
None
Supervisor of inpatient pharmacy is responsible to follow the Implementation of this policy.
Head Nurse
4.0 POLICY
This Hospital maintains mobile supplies of emergency equipment and medications (crash cart) in patient
care areas. The Pharmacy and (CPR) (Cardiac pulmonary resuscitation) Committee determines which
medications will be stocked in crash carts. The Pharmaceutical Care Department is responsible for the
integrity and security of medications contained in the crash cart.
Emergency drugs and supplies for use in medical emergencies only, shall be
immediately available at each patient care unit of service area. Emergency drugs for
resuscitation shall be located in the emergency crash carts.
The emergency drug supply will remain inside the cart, sealed, at all times when not in use. The seal will
be broken only when emergency situation arises. The contents shall be listed in a log on top of the cart and
shall include the earliest expiration date of any drugs within the tray.
Nurses on duty will refill the used emergency drugs.
The departments in which emergency carts are kept are as follows:

Intensive care unit departments
Emergency department
NICU-128


- In-Patient Departments
- Operating Room
- Delivery Room
- Out-Patient Departments
- X-ray department
5.0 PROCEDURES
Pharmacy Procedures:
The emergency drug supply shall be stored in each crash cart. The contents of the tray shall be listed in a log on
top of the cart and shall include the earliest expiration date of any drugs within the tray.
Crash cart medication through out the hospital is fixed, standard according to the table attached.
(Pediatric list)(Adult list) and distributed to all departments.
Crash cart list is updated according to Saudi Heart / American Heart Association recommendation.
The emergency drug supply is stored in a clearly marked portable container, is sealed which can not be broken
and have protection from loss or theft.
The contents are listed on the outside cover and include the earliest expiration date of the drugs within.
should be stored in a safe place under supervision of nurses and pharmacists monthly.
The emergency medication is monitored by replacing the expired or damaged drugs from it and records in the
pharmacy report.
5.1.8 The pharmacist will inspect the drug supply monthly as part of a monthly unit inspection.
Nursing Procedure:
The nurse will inspect the seal’s integrity once a day.
Immediately following an emergency, cardiac arrest sheet (CPR Sheet) should be accomplished. Original will be
attached in the patient’s chart and the copy will be forwarded to the cardio resuscitation (CPR) committee
through the CPR leader.
After the emergency crash cart has been used, nurses on duty is responsible for cleaning all used instruments on
the cart, cleared all of disposable items, with replacement of completely equipped and standardized
emergency crash cart.
Head nurse will recheck and document medication with pharmacist whenever emergency cart is used, and at the
end of the month (monthly).
Patient care units head nurses and nursing staff are responsible for checking the integrity of all equipments on top
of the crash cart every shift and must be documented.
NICU-129


a. Defibrillators will be discharged on battery to verify defibrillator battery charging.

b. Portable oxygen tank located beside the crash cart should be checked at the beginning of
the shift and after each used.
c. Portable suction machine should be checked for adequate function.
d. Check availability of Ambu bags and reservoirs, drug calculation charts, ET tube (for
neonates, pediatrics, and adults) box for sharps and needles.
5.2.6 Universal pediatrics, neonates and adult dosing guidelines will be kept on every emergency
crash cart in the units.
6.0 ATTACHEMENTS
6.1 Crash cart checklist.
Stethoscope
Electrodes for Adult/ Pediatric
Gel, Gloves
Torch, Time Clock
Suction Tube, Naso Gastric Tube
Blade & Scalpel Blade
Face mask
Oropharyngeal airway, Nasopharyngeal airway
Laryngeal mask
Laryngoscop set blades
Stylet, Magil’s forceps
ET Tube
Scissor, Syringes
Plaster, Batteries, Lidocaine gel
Tourniquet , Alcohol swab, Gauze
IV. Cannula all size, Butterfly
CVP set, Surgical set
IV set, Micro dropper, 3 ways AY stopcocks
8.0 REFERENCES
Policy of dispensing system (1021).
Policy of labeling system (1032).
Resource Manual KFSH and Research (CD) 2007.
Resource Manual JCAHO (CD).
NICU-130


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-131

TITLE: Equipment Check-up and Testing

1.0 PURPOSE
To maintain good condition of hospital equipment for the safety of the patients.
To maintain the skills of the staff in the use of equipment including trouble - shooting.
3.0 DEFINITION
None
Responsible to Head Nurse.
4.0 POLICY
It is the responsibility of all staff in the unit to assure good maintenance and functions of medical
equipment before it will be used to patients.
Any malfunction equipment must be reported immediately to Maintenance Department. Make a job order
and call maintenance in the extension 2689, 2696. Periodic preventive maintenance (PPM) must be done
regularly by the Biomedical Department
“Out of order” tag should be placed on top of a machine that is malfunction, and endorse to Charge Nurse
of the incoming shift in case Bio-medical technician was not able to repair and take the machine.
5.0 PROCEDURES
Switch on the equipment.
Check all the indicator if it is functioning.
In case of malfunction, call the Biomedical Technician Extension 2689 – 2696.
Put “Out of Order” tag on the equipment and remove from the patient’s room and endorse to
the incoming shift, till the equipment is fixed and ready for use.
Clean the equipment before and after patient’s used.
NICU-132


Ventilator
a. Check power supply, O2 and any leakages and damages on tubing or
humidifier container by checking test lung.
b. Should be checked by staff daily.
c. Should be checked by Bio-medical technician weekly.
d. PPM should be done twice a year by biomedical technician.
Defibrillator
a. Check the power supply and working condition of the machine in each shift by
assigned Nurse and record the observation.
b. PPM should be done by Biomedical department.
ABG Machine
a. Assigned nurse in each shift should check the functioning of the machine before
calibration.
b. Different kinds of solution gases must be replaced by bio-med technician
whenever needed.
c. PPM should be done by responsible company twice a year.
ECG Monitor
a. Check the power supply, confirm good working condition by switch on the
machine daily.
b. Monitor continuously if machine is used by the patient.
c. PPM should be done by the responsible company or Biomed twice a year.
NICU-133


CTG Machine
a. Check the power supply, switch on the machine and confirm good working
condition before use.
b. Should be checked daily by the staff.
Infusion Pump
a. Check the power supply, proper connection and working condition before use.
b. Check any alarms when in use.
Syringe Pump
a. Check the power supply and working status of system before use.
b. Check the proper connection of tubings on the pump.
c. Periodic check-up by the company or Biomed every 6 months.
Pulse Oxymeter
a. Check the power supply, working status and proper connection before use.
b. Check for the proper placement of the probe by the staff.
c. Periodic check-up by the company or Biomed every 6 months.
ECG Machine
a. Check the power supply and working condition of the machine before use.
b. Check for the proper placement of ECG paper.
c. Check for the proper connection of chest leads and limb leads.
d. PPM should be done by the responsible company or Biomed twice a year.
NICU-134


6.0 ATTACHEMENTS
6.1 Job Order request.

Gloves.
Ventilator.
Defibrillator.
ABG machine.
ECG monitors.
CTG machine.
Infusion Pump.
Syringe Pump.
Pulse Oxymeter.
ECG machine.
8.0 REFERENCES
8.1 Medical Consultants Network Inc. CD
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-135

TITLE: Gastric Aspiration

1.0 PURPOSE
1.1 To be able to obtain specimen for diagnostic purposes.
2.0 DEFINITION
Gastric aspiration is a procedure by which the stomach content is aspirated with an oral or
nasogastric tube.
4.0 POLICY
Gastric Aspiration must be done by a staff nurse upon written order of the
physician.
Aseptic technique for specimen collection must be instituted.
The size of the nasogastric tube inserted must depend on the size and age of the
patient .

5.1 Explain the nursing practice and procedure 5.1 Knowledge of the procedure alleviate patient’s
to patient. anxiety & promotes cooperation
5.2 Keep patient on NPO for 8-10 hours prior to
procedure.
5.3 Perform hand hygiene and collect and 5.3 Availability of the equipment to be used facilitates
prepare the equipments. readiness of the procedure.
5.3 Position and drape the patient. 5.4 Draping the patient ensures privacy and also to
protect her gown from spills.
5.4.1 Place bigger children in semi 5.4.1 This position allows for easy
fowlers position unless contraindicated. passage of the catheter, facilitates
For infant position on side with a diaper observation and helps avoid
roll placed under the shoulder. obstruction of the airway.
5.4 Measures approximately the nasogastric 5.5 Pre- measuring the catheter provides
tube to be inserted. Measure distance from guidelines on how far to insert catheter.
NICU-136


tip of the nose to bottom of earlobe then to

the end of Xyphoid process.
5.6 Wear Gloves. 5.6 To maintain sterility and also serves as

protection from exposure to body fluids.
5.7 Lubricate the tube and insert it gently but 5.7 Swallowing motion will cause esophageal
firmly inward and backward along the floor peristalsis, which opens the sphincter and facilitate
of the nose to nasopharynx. Passage of the passage of the catheter.
catheter may be synchronized with the
swallowing of the patient.
5.8 When nasogastric tube has been inserted, 5.8 When introducing air, gurgling sound over stomach
carry out test to confirm tube placement. is audible with stethoscope.
5.9 Secure the tube with the tape when tube 5.9 This prevents movement of the catheter from the
placement is confirmed. pre-established correct position.
5.10 Aspirate the stomach contents. Either 5.10 Observe the characteristic of the gastric
continuous or intermittent aspiration will aspirate. Report to the physician for any
be ordered by the medical practitioner. abnormal changes observed.
5.11 Collect specimen and place in sterile 5.11 Collected specimen must be
specimen container, label and transfer to transported immediately for diagnostic
laboratory accompanied by properly purposes. Delay of sending specimen
filled laboratory request. for analysis may alter the result.
5.12 Dispose used equipment safely. 5.12 To prevent cross- contamination.
5.13 Document the size & type of tube inserted, 5.13 To provide information that is helpful in treating
color & amount secretions aspirated, and the patient.
the patient’s tolerance to procedure.
6.0 ATTACHEMENTS
6.1 Laboratory request form

Gloves.
Nasogastric Tube.
Specimen container.
NICU-137


8.0 REFERENCES
Ministry of Health Policy and Procedure, (CD)
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-138

TITLE: Intravenous Therapy & Cannulation

1.0 PURPOSE
To restore and maintain fluid and electrolyte balance and body homeostasis when oral intake
is not adequate.
To correct concurrent losses from the gastrointestinal tract as a result of vomiting, diarrhea, or drainage of
secretions.
2.0 DEFINITION
Intravenous Therapy – refers to the infusion of fluids directly into the venous
system, including safe administration of blood / blood components and
intravenous medications ordered by the physician.
ICY
Intravenous insertion should be performed by a competent certified Intravenous therapy
nurses, or a physician.
Intravenous insertion should be performed under strict aseptic technique.
Standard precaution for blood and body fluids should be observed.
Site of canula insertion preferably the upper extremities starting from the distal to proximal.
Superficial veins are used more frequently because they are accessible and there are fewer
complications than when deep veins are used.
After two (2) unsuccessful attempts of Intravenous insertion, assistance must be obtained
from the expert certified IV nurse, if still unsuccessful inform the physician and document
it.
All Intravenous fluids must be administered by corresponding Intravenous sets and infusion
pump to ensure accuracy and safety.
Canula should be changed as needed, or every 72 hours for adult, or 120 hrs
(5 days) for Neonates, Pediatrics, and chronic patients that are very difficult to
NICU-139


be inserted. Date and time of insertion should be written with the nurse signature.
Intravenous set should be changed every 24 hours.
Intravenous Fluids started will be infused to the patient within 24 hours, remaining will be
discarded thereafter.
Normal Saline should be used to flush Intravenous line before and after IV medication
Infusion site must be checked at least every hour.

5.1 Check physician’s order for type of 5.1 To avoid medication error.
solution and rate to be infused.
5.2 Wash hands. 5.2 Maintain standard precaution.
Gather and assemble equipment:
Intravenous tray
Intravenous canula of appropriate gauge depends on
the age and size of the patient.
3 way Intravenous connector
Alcohol swabs, Betadine or
antiseptic solution.
Plaster or micro pore
Syringe w/ Normal Saline
Solution
Ordered Intravenous Fluid
Intravenous set, stand,
Infusion pump
Sterile gauze
Splint as required
Sharp’s container
Sterile or clean gloves
(optional).
5.4 Check the expiry date, sediment, and 5.4 To verify accuracy.
NICU-140


cracks, then calculate the rate to be infused.
5.5 Attached an Intravenous Fluid tag,

writing the name of the patient, amount,
name of medication added, number of
drops/minute, date and time started and to
be finished, with the signature of two nurses
who prepared.
5.6 Remove the cover of the Intravenous 5.6 Maintain sterility of the solution.
Fluid bottle and insert Intravenous set
into the rubber top observing aseptic
technique.
5.7 Identify correct patient. Explain the 5.7 To confirm correct patient’s identity and to gain
procedure to the patient, and parents for the cooperation.
children.
5.8 Flush 3 way connector with saline and 5.8 For flushing to maintain the patency of canula.
keep on sterile surface.
5.9 Select a suitable vein away fromthe joint
and bony prominence. Location: hands,
arms, feet and scalp. Look at the extremities
before the scalp.
5.10 Apply tourniquet, do not impair arterial 5.10 Improper application of tourniquet may cause
blood flow. blood stasis.
5.11 Disinfect the site with alcohol swab in 5.11 To avoid bacterial contamination.
acircular motion starting from inside out and
allow to dry.
5.12 Hold the canula with the bevel up; 5. 12 Bevel up position allows for smallest and
insert the needle into the vein. If there is a sharpest point of the needle to enter the vein.
blood return flow, removed the needle from
the catheter.
5.13 Release the tourniquet.
5.14 Attach 3 way connector with saline-
filled syringe to canula.
5.15 While flushing the canula, advance it
slowly then observe for subcutaneous
NICU-141


infiltration.
5.16 Secure the canula with tape. 5.16 To immobilize canula and prevent phlebitis.
5.17 Apply transparent dressing to site.
5.18 Label Intravenous site with date, time 5.18 To indicate the changing of Intravenous set
and signature of the staff every 24 hours and canula every 3-5 days.
5.19 Attached the Intravenous set to hub of 5.19 To ensure correct amount of fluid is being
the connector and adjust the infusion flow at infused.
the prescribed rate.
5.20 Observe local and systemic
complication during IV therapy.
5.21 Tidy the environment; dispose the
sharps in the sharp’s disposal container.
5.22 Documentation 5.22 Legal record is maintain to communicate to other
Date, time and site of insertion members of the Healthcare team.
Size of canula and Intravenous solution.
Patients response to
procedure.
6.0 ATTACHEMENTS
Intravenous Fluid Tag
Doctor's Order Sheet
Intravenous tray
Intravenous canula of appropriate gauge depends on the age and size of the patient.
3 way Intravenous connector
Alcohol swabs, Betadine or antiseptic solution.
Plaster or micro pore
Syringe w/ Normal Saline Solution
Ordered Intravenous Fluid
Intravenous set, stand, Infusion pump
Sterile gauze 7.10Splint as
required 7.11Sharp’s container
7.12 Sterile or clean gloves (optional).
NICU-142


8.0 REFERENCES
Nursing Procedures, 2nd Edition by Springhouse
Lippincott, Manual in Nursing Practices, 7th Edition by Nettina
Photo Guide of Nursing Skills, 2004 by Smith, Duell, Martin
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-143

TITLE: Isolation of the Newborn

1.0 PURPOSE
1.1 To control cross infection.
2.0 DEFINITION
None
Responsible to Head Nurse/ Head of NICU Department.
4.0 POLICY
Infants delivered by a mother suspected or proved of having communicable / infectious
diseases are placed in the isolation nursery as ordered by the physician.
Infants delivered outside the hospital with positive culture are admitted in the Isolation
Room, but if no evidence of infection will be admitted to out born Nursery.
4.2 Patients with positive culture to any infectious diseases must be cared in
Isolation Room as ordered by the physician.
4. Standard precaution and transmission based precaution must be observed, and
to follow Infection Control guidelines.

5.1 The nurse obtains supplies for the patient to
last for 2 days, including formula and
nipples for each shift.
5.2 Wash hands, use gloves or appropriate

personal protective equipment before
caring infant.
5.3 Place infant’s individual supplies into the
isolate cabinet.
5.4 Follow routine procedures for the disposal
of linen and trash.
NICU-144

TITLE: Isolation of the Newborn

5.5 Remove gown and gloves, wash hands

before leaving the room and wash
hands again in the anteroom.
5.6 Collect cultures, administer antibiotics and
carry out any other special procedures as
ordered by the physician.
5.7 Observe all infants for early symptoms of
infection.
6.0 ATTACHEMENTS
None

Gloves
Mask
Gown
Eye protection, face shield if procedures likely to generate splashes.
8.0 REFERENCES
Infection Control Guidelines by Wafa Abdullah Al-Trazi
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-145

TITLE: Narcotic and Controlled Drug Administration

1.0 PURPOSE
1.1 To standardize the procedure of administering Narcotics and Controlled
drugs in compliance with the Ministry of Health guidelines and Jeddah
Maternity and Children’s Hospital policy.
2.0 DEFINITION
Narcotic and Controlled Drug Administration - an introduction of substances
or compounds considered to have limited medical use or that are potential for
abuse or addiction.
4.0 POLICY
Narcotic storage cabinet is safe, made of steel and should be double lock at all times.
Narcotic key should always be with the Head Nurse or Charge Nurse.
Narcotics should be ordered and prescribed by Consultant Physician, and must be re
ordered if still needed by the patient after 24 hours.
Injectable Narcotic or controlled drugs prescribed by the Consultant should be administered to patients
inside the hospital not outside the hospital or at home.
Prescribed Narcotic should be documented in the patient’s file.
Telephone orders/verbal orders of Narcotics and controlled drugs should not be
accepted.
The Narcotic is issued and counter checked by the Head Nurse/Charge Nurse from the
Narcotic cabinet to administering Nurse.
Vital Signs should be taken and general assessment to patient must be considered
before administering Narcotics.
NICU-146


Registered Nurses (RN) should observed 7 rights of drug administration before giving Narcotic
and Controlled drugs.
There should always be a witness, a qualified RN during Narcotic administration and during
disposing an extra portion. Any extra medication from an ampoule that is discarded should be
documented. Write the exact amount of Narcotic discarded in the prescription form and
Narcotic book, counter signed by the witness.
A Narcotic prescription form is completed by the medical practitioner with his signature and stamp.

5.1 Confirm doctor's order and observe seven
rights of drug administration
5.2 Wash hands
5.3 Vital signs should be taken and recorded.
Assessment:
Assess for respiratory dysfunction, including
respiratory depression, rate, rhythm, character;
notify the Physician if respiration is below
normal range.
Assess for intake and output ratio; be alert for
urinary retention, frequency, dysuria; drug
should be discontinued if these occur.
Observe for Central Nervous System (CNS)
changes, dizziness, drowsiness, hallucination.
5.5 Prepare the Narcotic drug as ordered and

should be checked by both Registered Nurses.
NICU-147


5.6 Approach the patient and check identity by

both Nurses prior to administration using at
least 2 identifiers.
5.7 After administration, both Nurses should
complete and sign the Narcotic Prescription.
5.8 The administering Nurse will sign the
medication sheet and document in the Nurses’
notes.
5.9 Patient should be observed closely after
narcotic administration.
6.0 ATTACHEMENTS
Physician's Order Sheet
Medication Sheet
Narcotic & Controlled drug prescription
Narcotic Logbook

Dinamap Monitor.
Stethoscope.
Kidney basin.
Medication.
8.0 REFERENCES
Fundamentals of Nursing by B. Kozier, A. Berman, S. Snyder; 7th Edition, 2004
Mosby’s Nursing Drug Reference by L. S. Roth
Jeddah Maternity & Children's Hospital Pharmacy Department on Narcotic and Controlled Drug Policy
and Procedure
NICU-148


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-149

TITLE: Narcotic and Controlled Drug Endorsement and Storage

1.0 PURPOSE
To keep an accurate record of Narcotic and Controlled drug.
To detect if any Narcotic drug or empty ampoule is missing.
To establish a safe practice for the storage of Narcotic and Controlled Drug available in the nursing
unit for immediate use.
2.0 DEFINITION
Endorsement of Narcotic and Controlled drug refers to the hand over of
responsibility for Narcotic and other Controlled drug from outgoing nurse
to the in-coming nurse.
4.0 POLICY
Narcotic storage cabinet is safe, made of steel and should be double-locked at all times.
Narcotic key should always be with the Charge Nurse of each shift.
Always endorse the Narcotic key to a responsible RN, every time the Charge Nurse is
out of the unit.
Auditing of Narcotic and Controlled Drug should be done by in-coming and out going
charge nurses; both should be present during the counting and should sign in each other’s
presence.
Both outgoing and in-coming Charge Nurses will count the number of empty ampoules that
should be equal to the number of prescriptions with completed administered doses, the
number of full ampoules should be equal to the number of doses not given, and Narcotic
record book should be signed by both charge nurses.
Any lost Narcotic or broken ampoules should be reported immediately to the Head Nurse
or Nurse Supervisor, an incident report must be submitted to the Director of Nursing
through proper channel.
NICU-150


When using only part of the dose or ampoule, remaining portion must be discarded with
the presence of a witness. Write the exact amount of Narcotic discarded in the
prescription form and Narcotic book, countersigned by the witness.
Replacement of stock should be done by the Head Nurse or authorized staff, empty
ampoules with completed drug prescription must be replaced by the Pharmacist in-
charge of Narcotic.
4.10 If Narcotic key is lost, staff on duty should not leave the unit unless the
Narcotic steel cabinet is open (by Maintenance Department), and the Charge
nurse must confirm the availability of the drugs. Incident report should be
written, lock should be changed immediately.

5.1 Count at the end of every shift all narcotics
and controlled drugs in the presence of a
witness and the head nurse or charge nurse.
Record and sign in the Narcotic
endorsement book.
5.2 Auditing of narcotic and controlled drug
should be done by in-coming and outgoing
Charge Nurses in the presence of a
witness.
5.3 Charge Nurses will count the number of
empty ampoules that should be equal to the
number of prescriptions with completed
administered doses.
5.4 The number of full ampoules should be
equal to the number of doses not given;
Narcotic record book should be signed by
both Nurses.
5.5 Inform the Head Nurse and Nurse
Supervisor if discrepancies were observed.
5.6 If the discrepancy is not solved, submit an
incident report to the Director of Nursing
through proper channel.
NICU-151


5.7 Replace wasted materials of drug lost

through breakage or spillage within 24 hours
with the corresponding report to the Director of
Nursing.
5.8 When using only part of the dose or
ampoule, the waste portion must be
documented and “DISCARDED” written in the
Narcotic record book, and Narcotic
prescription.
6.0 ATTACHEMENTS
Narcotic endorsement logbook
Narcotic record book with details of administration
Narcotic prescription

Dinamap Monitor.
Stethoscope.
Kidney basin.
Medication.
8.0 REFERENCES
Fundamentals of Nursing by B. Kozier, A. Berman, S. Snyder; 7th Edition, 2004
Mosby’s Nursing Drug Reference by L. S. Roth
Jeddah Maternity & Children's Hospital Pharmacy Department on Narcotic and Controlled Drug Policy
and Procedure
NICU-152


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-153

TITLE: Nasogastric Feeding

1.0 PURPOSE
1.1 To provide a means of alimentation and administration of medication when the oral route is
inaccessible.
2.0 DEFINITION
Nasogastric Tube for feeding is - a means of providing food by way of a catheter
passed through the nose or mouth, through the pharynx down the esophagus
and into the stomach, slightly beyond the cardiac sphincter.
4.0 POLICY
Nasogastric tube must be in correct position and properly fixed before
commencing gavage feeding.
The size of the nasogastric tube should be according to the age and size of the patient
and the viscosity of the solution being fed.
Nasogastric tube feeding should be given by gravity and should not be pushed by
force.
The nasogastric tube should be aspirated every 4 hours unless otherwise ordered by
a physician. The amount of aspirate will be recorded on the intake and output sheet
every 8 hours.
After giving feeding, the nasogastric tube should be rinsed with water and close after
rinsing.
A general statement of formula type, volume and feeding tolerance should be recorded
in the nurses' notes.
NICU-154



5.1 Explain procedure to patient. Assess bowel 5.1 This facilitates cooperation and provides
sound through the use of stethoscope. reassurance for patient. Presence of bowel sounds
indicates functional gastrointestinal tract.
Assemble equipment. Check the amount 5.2 This provides organize approach to procedure.
concentration, type, and frequency of tube Ensure that correct feeding will be administered.
feeding on patient's chart. Check expiration of Outdated formula may be contaminated.
formula.
Nasogastric tube of appropriate size (# 5-12
French)
Clear calibrated reservoir for
feeding fluid
Syringe
Stethoscope
Feeding fluid at room temperature
Disposable gloves
Sterile water for irrigation
Asepto syringe for larger volume
of Feeding
Disposable pad or towel.
5.3 Wash hands and don gloves. 5.3 Hand washing deters the spread of
microorganism. Gloves protects from exposure
to body fluids.
5.4 Position patient with head of bed elevated 5.4 This position minimizes possibility of aspiration
at least 30 degrees. into the trachea.
5.5 Check proper positioning of the 5.5 A nasogastric tube left in place can become
nasogastric tube before commencing dislodged between feedings. Aspiration may
feeding. cause serious respiratory problem if gastric tube
is not in proper place.
5.6Aspirate the stomach contents before 5.6 This is done to monitor for appropriate fluid
feeding started and measure the intake, digestion time, and over feeding that can
amount prior to administering the cause distention. Note an increase in gastric
feeding. residual contents.
5.7 The flow of feeding should be slow. Do 5.7 The rate of flow is controlled by the size of the
not apply pressure. Elevate reservoir 6-8 feeding catheter; the smaller the size, the slower
NICU-155


inches above the patient's head. the flow. If the reservoir is too high, the pressure
of the fluid itself increases the rate of flow.
5.8 Formula taken too rapidly will interfere 5.8 The presence of food in the stomach stimulates
with peristalsis, causing abdominal peristalsis and cause the digestive process to begin.
distention and regurgitation. When tube is in place, incompetence of the
esophageal- cardiac sphincter may result in
regurgitation.
5.9 When feeding is completed, the catheter 5.9 Clamp the catheter before air enters the
may be irrigated with clear water. Before the stomach and causes abdominal distention.
fluid reaches the end of the catheter, clamp it Clamping also prevents fluid from
off and keep in place for the next feeding. dripping from the catheter into the
pharynx, causing the patient to gag and
aspirate.
5.10 Place the patient on right side for at 5.10 To facilitate gastric emptying and
least one hour. Observe patient's minimize regurgitation and aspiration.
condition after feeding; bradycardia and Bradycardia and apnea may occur because
apnea may still occur. of vagal stimulation.
5.11 Note for any vomiting or abdominal 5.11 It may occur due to overfeeding or too rapid
distention. feeding.
5.12 Note patient's activity. 5.12 Peaceful sleep offers insight as to tolerance of
the feeding.
5.13 Accurately describe and record 5.13 This provides accurate documentation of the
procedure, including, type and amount of procedure and the care given to the patient.
formula, amount retained or vomited and how
the patient tolerated the procedure.
6.0 ATTACHEMENTS
Intake & Output chart
Nurse's Notes

Nasogastric tube of appropriate size (# 5-12 French)
Clear calibrated reservoir for feeding fluid
Syringe
Stethoscope
NICU-156


Feeding fluid at room temperature

Disposable gloves
Sterile water for irrigation
Asepto syringe for larger volume of Feeding
Disposable pad or towel
8.0 REFERENCES
Nursing Procedures, 2nd Edition by Springhouse
Fundamentals of Nursing, 7th Edition by Kozier, Erb, Berman, Snyder
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-157

TITLE: Nasogastric Tube Insertion

1.0 PURPOSE
To decompress the stomach thus gastric distention, nausea and vomiting.
To administer tube feeding and medication to patient unable to eat by mouth or swallow a
sufficient diet without aspirating food or fluids into the lungs.
To remove stomach contents for laboratory analysis.
To lavage the stomach in case of poisoning or overdose of medications.
2.0 DEFINITION
Nasogastric tube is a tube (rubber or plastic tube) with radiopaque marker or strip
at the distal end passed into the stomach via the nose to remove gas or stomach
contents or for decompression post operatively and for feeding purposes.
4.0 POLICY
Nasogastric tube may be inserted by the physician or by a qualified nurse with the order of
the physician.
Insertion of nasogastric tube requires close observation of the patient and verification
of proper placement by x-ray studies.
Nasogastric tube must be changed every seven days unless ordered by a physician.
The date of change must be recorded in the nursing care plan and nursing notes.
The length of the nasogastric tube must be measured from the tip of the nose to the bottom
of the earlobe to the end of xyphoid process.

5.1 Explain to the patient or parents of children 5.1 Knowledge of the procedure eases anxiety and
about the procedure. promotes cooperation.
5.2 Position the patient to a high fowler’s 5.2 It is often easier to swallow in this position and
position if health permits and support the head gravity helps the passage of the tube.
on a pillow.
NICU-158


Prepare equipment at bedside: To ensure readiness of the procedure.

Nasogastric tube # 5-10 french
If rubber tube is used, place it on ice.
f a plastic tube is being used, place it in warm water. This stiffens the tube for easier insertion.
Non-allergenic adhesive tape
Gloves This makes the tube more flexible, facilitating
Water soluble lubricant insertion.
tethoscope
yringe as irrigation set
uction equipment if required
Restraints
Gauze swabs
5.4 Determine how far to insert the tube. 5.4 This length approximates the distance from the
Measure from the tip of the nose to nares to the stomach but it varies among
tip of the earlobe to the end of xyphoid individuals.
process.
5.5 Wash hands and don gloves. 5.5 To protect the nurses from contact of body fluid
(secretions).
5.6Lubricate the tip of the tube with water 5.6 A water soluble lubricant dissolves if the tube
soluble lubricant. accidentally enters the lungs.
5.7 Insert the tube, with its natural curve toward 5.7 Hyper extension of the neck reduces
the patient into the selected nostril. the curvature of the nasopharyngeal
Hyperextend the neck and gently advance junction.
the tube toward the nasopharynx.
Do not hyperextend or hyper flex an infant’s neck: Hyper extension and hyper-flexion of the neck could
If the patient swallows, passage of the occlude the airway.
catheter may be synchronized with the Swallowing motions will cause esophageal
swallowing. Do not push against resistance. peristalsis, which opens the cardiac
Gently try rotating the tube if resistance is sphincter and facilitates passage of the
met. catheter.
If there is no swallowing, insert the
catheter smoothly and quickly. Because of cardiac sphincter and spasm,
resistance may be met at this point. Pause a few
seconds then proceed.
NICU-159


5.8.3 If infant especially, observe for vagal 5.8.3 Stimulation of the vagus nerve
stimulations. branches with the catheter will
directly affect cardiac and
pulmonary plexus.
Once catheter has been inserted to the pre
measured length, ascertain correct tube
placement by:
nject 0.5-1 ml. air for small infants and up to 5 ml. in The gurgling or growling sound over the
larger children into the catheter while hypogastrium indicates that the catheter is in proper
simultaneously listening with stethoscope the location.
typical gurgling or growling sound over the
hypogastrium.
Aspirate injected air from the stomach. To prevent abdominal distention.
Aspirate small amount of stomach content and Failure to obtain aspirate does not indicate improper
test acidity by pH tape. placement; there may not be any stomach content or
the catheter may not be in contact with fluid.
5.10 Secure the tube by taping to the bridge of 5.10 Taping in this manner prevent the tube from
the patient's nose and bring split ends under pressing against and irritating the edge of the nostril.
the tubing and back up over the nose.
5.10.2 For infants or small children, tape
the tube to the area between the end of the
nares and the upper lip as well as to the
cheek.
5.11 Record the date & time the NGT inserted, 5.11 Measurement of the tube provides a baseline for
type and size of the tube and length of the future comparison.
tube inserted and document patient's response
to the procedure.
6.0 ATTACHEMENTS
6.1 Laboratory request
NICU-160



Nasogastric tube # 5-10 french If rubber tube is used, place it on ice. If a plastic tube is being used, place
it in warm water.
Non-allergenic adhesive tape
Gloves
Water soluble lubricant
Stethoscope
Syringe as irrigation set
Suction equipment if required
Restraints
Gauze swabs
8.0 REFERENCES
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-161

TITLE: Nurses Certified in Basic Life Support (BLS) & Neonatal

Resuscitation Program (NRP)
1.0 PURPOSE
1.1 To establish efficiency of NICU staff to respond during emergency situation
and related nursing situations requiring the practice of Cardio Pulmonary
Resuscitation (CPR) that is current and according to standard of patient care.
2.0 DEFINITION
BLS - Basic Life Support
NALS / NRP – Neonatal Advance Life Support / Neonatal Resuscitation Program.
4.0 POLICY
All new NICU staff are required to present certification of a current BLS upon hired
otherwise they should be certified within 3-6 months, and will be scheduled for NRP.
All nursing staff assigned in Neonatal Intensive Care Unit must be (Neonatal
Resuscitation Program) NRP certified. They must maintain NRP skills as
evidenced by an annual update review or recertification class.
It is the responsibility of the NICU staff to maintain a current BLS / NRP Certification and
provide evidence of recertification. A copy of the BLS and NRP certificates will be kept in
the employee’s file and will be updated before the expiry date.

BLS Initial Certification:
All nursing staff having direct patient contact is
required to be BLS certified.
If the staff has never been certified, then Head nurse will
submit the name of the new staff to Nursing
Education Department to attend an 8-hour initial
certification class.
NICU-162


5.2 BLS Re-certification:

5.2.1 Each staff with direct patient contact
will recertify his/her BLS card every
2 years at least 30 days before expiry
date.
5.3 NALS/NRP Certification:
5.3.2 All nursing staff assigned in
Neonatal Intensive Care Unit are
required to have NRP certificate.
Nursing Education will schedule the
staff to take NRP training and pass the
examination in King Fahd Armed
Forces Hospital or in Soliman Fakeeh
Hospital.
5.4 List of Staff with BLS and NRP Certificate is
attached.
6.0 ATTACHEMENTS
Copy of Certificate for each staff attached to their file.
List of BLS / NRP certified in NICU.

None
8.0 REFERENCES
Saudi Heart Association BCLS-NRP Manual
American heart Association BCLS-NRP Manual
NICU-163


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-164

TITLE: Nursing Care of Infant with Hyaline Membrane Disease

1.0 PURPOSE
To maintain adequate ventilation and oxygenation.
To promote adequate hydration and electrolyte status. Hyaline membrane disease is a syndrome of
premature infants that is characterized
2.0 DEFINITION
by a progressive and frequent fatal respiratory failure resulting from atelectasis and immaturity of
the lungs.
4.0 POLICY
The staff nurse must have knowledge of the disease.
Maternal and birth history must be taken as a tool in assessing the infant’s condition.
Strict hand washing should be observed in handling neonates.
The nurse must be alert in case of emergency. Crash cart and intubation equipment must be ready in
case needed.
The nurse should always be ready to assist the physician in emergency procedures such as intubation,
umbilical cannulation and surfactant administration.
The infant should be placed in the radiant warmer upon admission until temperature is stable.

5.1 Strict hand washing before attending to 5.1 To maintain standard precaution and to prevent
patient nosocomial infection.
5.2 Maternal history and birth should be taken 5.2 Determines gestational age of infant.
Assess the infant’s respiratory status:
Determine the severity of retractions. 5.3.1 To determine the degree of respiratory
disease.
Identify any period of apnea, and the
duration.
NICU-165


Note any cyanosis.

Auscultate chest for diminished breath sound and
presence of crackles.
5.4 Monitor and record vital signs including
blood pressure, oxygen saturation and
weight.
Promote adequate gas exchange.
Administer supplemental oxygen at prescribed To prevent hypoxia and increasing respiratory
concentration by hood, nasal prong or distress.
adequate tube.
Observe infant’s response to oxygen Note response by improvement in
therapy. arterial and capillary blood gas.
Observe for apnea. Stimulate infant if If unable to produce spontaneous respiration
apnea occurs. with stimulation, initiate
resuscitation.
Assist with endotracheal intubation and maintain
To improve oxygenation by preventing alveolar
mechanical ventilation as indicated. collapse and increasing diffusion time.
Place patient in prone position. To allow maximum lung expansion. This
position provides for a larger lung
volume because of the position of
the diaphragm. Decreases energy
expenditure and increase time spent
in quiet sleep, but it may also
present several problems:
a. the chest might be obstructed
b. retractions are difficult to detect.
c. abdominal distention is difficult
to recognize.
uction secretions based on the assessment of the infant. Suction as needed because the gag reflex is
Observe for complications of suctioning such as weak and cough is ineffective. Report
bronchospasm, bradycardia, hypoxia, trauma to to the physician for any sign of
airway infection and pneumothoraces. complication. Hyper- ventilate
patient prior to suctioning to
NICU-166


5.5.7 Assist physician in the administration of prevent hypoxia.

surfactant.
Assist physician during diagnostic
evaluation:
To check for biochemical abnormal- lities and to
Blood collection for glucose and serum calcium, CBC
and blood C/S. determine the intervention to be applied.
To correct acidosis and hypoxia and adjust
Arterial blood gas analysis. ventilator setting accordingly.
To determine the degree of the
Chest X-ray disease and to distinguish RDS from
pneumonia.
Promote adequate nutrition and hydration.

Administer IV fluids or enteral feeding as needed and To prevent fluid overload.
observe infusion rate closely.
Observe IV sites for infiltration or infection; use
aseptic technique. To prevent sepsis.
Administer tube feeding or parenteral
nutrition as ordered. To provide adequate caloric intake.
Monitor intake and output closely and weight infant
daily. To determine the degree of hydration.
Maintain thermoregulation:
Place infant in isolette or radiant warmer to provideToa prevent hypothermia which may result in
neutral thermal environment. vasoconstriction and acidosis.
Adjust isolette or radiant warmer to obtain
desired skin temperature. Radiant warmer should be used with caution
to infant less than1,250 grams,
because of increased water loss and
potential for hypoglycemia.
5.9 Encourage parental attachment:
5.9.1 Encourage the parents to ask questions 5.9.1 To provide information concerning
concerning patient’s condition & the disease process, expected
participate in the plan of care. outcome and usual course of the
NICU stay.
NICU-167


Call parents to update them on the infant’s To alleviate their anxiety and prepare parents
condition until they will visit the child. what to expect on their visit.
Advice to give breast milk to feed infant
when enteral feeding is ordered. To promote mother and infant
Record all information regarding illness and bonding.
interventions rendered; and the patient’s To provide assessment, progress or
tolerance to the treatment. implication of the patient’s illness for the
continuity of care..
6.0 ATTACHEMENTS
None

7.1 Oxygen source
7.2 Intubation equipments
7.3 Suction equipments
7.4 Surfactant
7.5 Radiant warmer / isolette
7.6 Umbilical cannulation equipment if needed
7.7 Intravenous tray with equipments
7.8 Intravenous solution
7.9 Crash cart
7.10 Syringe pump
8.0 REFERENCES
Lippincott Manual in Nursing Practice 7th Edition by Nettina
Neonatology Management, Procedures on Call Problems Disease and Drugs 5th Edition by Tricia Lacy
Go
NICU-168


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-169

TITLE: Oxygen Therapy

1.0 PURPOSE
To promote tissue oxygenation
Oxygen Therapy is administered in the following circumstances:
Respiratory diseases such as chronic obstructive airway diseases, pulmonary
infarction/embolus, asthma.
Chest injuries following trauma when the mechanism of respiration may be impaired.
Heart disease when the cardiac output is reduced e.g. Myocardial Infarction,
Congestive Heart Failure.
Hemorrhage when the oxygen carrying capacity of the blood is reduced.
Pre – operatively and post-operatively when analgesic drugs may have an
effect on respiratory function e.g. narcotics.
In emergency situation e.g. cardiac or respiratory arrest, cardiogenic,
bacteraemic or hemorrhagic shock.
2.0 DEFINITION
Oxygen therapy is the introduction of increased oxygen to the air available for
respiration to prevent hypoxia, a condition where insufficient oxygen is available
for the cells of the body especially in the brain and vital organs.
Oxygen masks are designed to give an accurate percentage of oxygen by entering
on appropriate amount of air as a specific flow rate of oxygen.
Different Mask Used:

2.1 Edinburgh Mask
The percentage of oxygen is adjusted by the flow rate at the flow meter only.
3.0 Hudson Mask
With this mask there are various attachments which can be used to give a more
specific percentage if prescribed; otherwise the percentage of oxygen is adjusted
directly by the flow meter.
NICU-170


4.0 Venturi Mask

Individual masks are available for specific percentage of oxygen and appropriate
flow rates given for each mask.
5.0 Nasal Canulae
These are light plastic tubes inserted into each nostril and shaped to fit over ears
to maintain the position. Patients find them less claustrophobic than a conventional
mask. They are not suitable for all patients as lower percentage of oxygen are not
accurately obtained and at higher percentage. Humidification is inadequate.
6.0 Oxygen Tents
For emergency resuscitation procedures, oxygen may be administered via an
Ambubag and resuscitation mask.
7.0 Humidifiers
It is important that the oxygen administered is adequately humidified to prevent
drying of the mucosa of the respiratory tract. There are various humidifiers
available when percentages of oxygen above 35% is prescribed.
4.0 POLICY
Effectiveness of the oxygen therapy must be monitored and recorded, Oxygen
concentration maybe adjusted according to assessment.
Except in emergency situations oxygen therapy will be prescribed by Medical
Practitioner who will specify oxygen concentration, the method of delivery, &
parameters for regulation (blood gas levels, pulse oximetry values).
The patient's general condition should be assessed to identify any deterioration or
improvement in the hypoxic state.
level of consciousness
respiratory status (rate, depth, signs of distress)
vital signs (blood pressure & pulse)
color and condition of the patient’s skin & mucus membrane, must be observed for
the presence of cyanosis, clamminess, or sweating.
NICU-171


The patient should be aware of the risk of fire while Oxygen is going on, dangers of smoking
should be explained to patient and visitors. “No Smoking” signs can help reinforce this
precaution.
Alcohol based solutions, ointments, and grease should not be used in areas where
oxygen is administered. These volatile substances are readily flammable and the
presence of oxygen will increase the risk of fire.
The administration of oxygen does not require aseptic technique, however standard precaution
should be maintained to prevent cross infection.
The respiration rate should be taken and recorded as frequently as necessary rating the
type and depth of the respirations.
Patients who have Bronchospasm can be helped by medication which includes
Bronchodilation, either systematically or via a nebulizer as prescribed.
Patients who have Chronic Obstructive Airway Disease (COAD) should be prescribed and
administered with low percentage of oxygen (24%-28% oxygen). Do not use more than 2
to 3 liters of nasal oxygen (30% face mask) without a Doctor’s order.
Oxygen tent or canopy is the most suitable oxygen delivery method for infants and young
children. They should not be exposed to a high percentage of oxygen for extended periods
unless ordered.
The removal of face masks for eating and drinking should be supervised by the nurse
and will depend on the patient’s condition. It may be possible to change to nasal
cannulae at meal time to maintain the accuracy of the oxygen percentage as
necessary.
4.12 Oxygen even when adequately humidified causes the mouth and nasal passages
to become dry, frequent oral and nasal hygiene will be required for the patients
comfort to maintain a healthy oropharyngeal mucosa.
NICU-172



5.1 Identify and confirmed the order for oxygen 5.1 To ensure accuracy of doctor’s order.
therapy.
5.2 Explain the procedure to the patient. 5.2 To gain patient's cooperation.
5.3 Explain the dangers of smoking to the
patient and visitors and display “No Smoking”
signs.
Collect and assemble the equipment:
Oxygen humidifier (distilled water if needed for
humidifier).
Oxygen source (wall or cylinder)
Oxygen flowmeter
Nasal cannula or face mask
Nonsterile gloves
“No Smoking” sign
Cotton balls
Washcloth
Petroleum jelly
5.5 Insert flow meter into outlet on wall, or 5.5 Allows for control of oxygen flow.
place oxygen cylinder near the patient.
5.6 Prepare humidifier with distilled water to 5.6 Delivers moistened oxygen to mucous membranes
the correct level, if needed. of airway.
5.7 Connect humidifier to flow meter then
attached the tubing to cannula or mask.
5.8 Turn on oxygen flow meter until bubbling is 5.8 Permits delivery of correct oxygen concentration.
noted in humidifier. Adjust the flow rate of
oxygen as prescribed.
5.9 Observe the flow of oxygen and water 5.9 To check that the equipment is working efficiently.
vapor through the mask or cannulae before
administering.
5.10 Apply face mask or nasal cannnula in the

correct position adjusted to fit firmly and
comfortably over the patient’s nose & mouth.
NICU-173


For Nasal Cannula:

Place cannula prongs into patient’s nares.
Slip attached tubing around patient’s 5.10.2 Aids in securing cannula and provides comfort
ears and under chin. Place cotton to patient.
between tubing and ear for comfort
Tighten tubing to secure cannula, but
make sure patient is comfortable.
For Face Mask:
Place mask over nose, mouth & chin
Adjust metal strip at nose bridge of mask
to fit securely over bridge of 5.10.4 Ensures correct fit.
patient’s nose.
Pull elastic band around back of head
or neck.
Pull band at sides of mask to
tighten.
Place cotton or gauze pad under
bridge of face mask.
5.11 Assist the Medical Practitioner when the

estimation of arterial blood gases is
required.
5.12 Remove nasal cannula each shift or every
4 hours to assess skin, apply petroleum jelly
to nares, & clean accumulated secretions.
Remove mask every 2 to 4 hours, wipe
away accumulated mist, & assess
underlying skin.
5.13 Observe all precautions to minimize the 5.13 Safety purpose
risk of fire throughout the procedure and
NICU-174


while the therapy still in use.

5.14 Position the patient for comfort with head 5.14 Facilitates lung expansion for gas exchange.
of bed elevated.
5.15 Dispose of or store equipment 5.15 Decreases spread of micro organisms.
appropriately.
5.16 Discard gloves to medical waste bag and 5.16 Reduces transfer of micro-organisms.
perform hand hygiene.
5.17 Evaluate respirations. 5.17 Aids in determining effectiveness of oxygen
administration.
Documentation:
Date & time Oxygen therapy started
Amount of oxygen & delivery method
Respiratory status before, during and after initiation.
Color of skin and mucous membranes
Teaching performed regarding therapy
& patient’s understanding
Blood gas results
Pulse oximetry levels
Pulse rate, respiratory rate
6.0 ATTACHEMENTS
6.1 No Smoking Signs.

Oximeter cable
Oximeter connector
Oximeter probe
Alcohol swab
NICU-175


8.0 REFERENCES
Fundamentals of Nursing, 7th Edition by Kozier, Erb, Berman, Snyder
NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-176

TITLE: Tracheostomy Care

1.0 PURPOSE
To prevent infection and maintain mucus membrane and skin integrity.
To prevent accumulation of secretions that can interfere with respiration.
To ensure airway patency by keeping the tube free of mucus build up.
2.0 DEFINITION
Tracheostomy care is - the care rendered to patient with an artificial hole through the
neck to the windpipe. The airway is kept open, humidity is provided and the
wound is kept sterile. Without such care patient could suffer injury to the
vocal cords, stomach problems, blockage of the windpipe and infection.
4.0 POLICY
Tracheostomy care should be performed using aseptic technique.
Gloves must be used for all manipulation at the tracheostomy site.
The nurse should focus on maintaining patency of airway, facilitating the removal of
pulmonary secretions and cleansing the stoma.
The nurse must closely monitor signs of complication such as hemorrhage, edema
around the stoma, accidental decannulation, tube obstruction and the entrance of free
air into the pleural cavity.
The physician should be notified for any complications.

5.1 Wash hand thoroughly. 5.1 To reduce the transmission of microorganism.
5.2 Perform any procedure that loosens 5.2 Promotes removal of secretions from all lobes of
secretions (e.g., postural drainage, percussion, lungs.
nebulization).
5.3 Assemble equipments and supplies. Check 5.3 To ensure sterility.
expiration date on sterile package and inspect
NICU-177


for tears.
Tracheostomy care kit
Sterile towel
Sterile gauze
Sterile cotton swabs
Sterile gloves
Hydrogen peroxide
Sterile water
Antiseptic solution & ointment (optional)
Tracheostomy tie tapes
(commercially available)
Tracheostomy securing device
Face shield
5.4 Assess the patient's condition and condition 5.4 To determine need for care. The presence of skin
of stoma such as redness, swelling, character of breakdown and infection must be monitored. Culture of
secretions presence of purulence or bleeding. the site may be needed.
5.5 Explain the procedure to the patient. 5.5 Knowledge of the procedure lessens the anxiety of
Provide privacy. the patient and to ensure cooperation as well.
5.6 Place the patient on side or semi-fowler's 5.6 To decrease abdominal pressure on the diaphragm
position unless it is contraindicated. thereby promoting lung expansion.
5.7 Put on face shield and sterile gloves. 5.7 Face shield prevents secretions from getting into the
nurse's eyes. Sterile gloves prevent contamination of the
wound by nurse's hands and also protect the nurse's
hands from infection.
5.8 Increase oxygen concentration to 5.8 Provides hyper oxygenation before suctioning.
tracheostomy collar or Ambu bag to 100%.
5.9 Using sterile technique, suction the length
of the tracheostomy tube.
5.10 Clear the external end of the tracheostomy 5.10 Designate one hand as contaminated
tube with 2 gauze sponges with hydrogen and reserve the other hand as sterile for handling
peroxide. sterile equipment.
5.11 Clear the stoma area with 2 peroxide- 5.11 Hydrogen peroxide may help loosen dry
soaked gauze sponges. Make only a single crusted secretions. To prevent contamination of a clean
sweep with each gauze sponge before area with a soiled pad.
NICU-178


discarding.
5.12 Loosen and remove crust with sterile 5.12 Ensures that all hydrogen peroxide is removed.
cotton swabs then clear the stoma area with
sterile water-soaked gauze sponges.
5.13 Clean the stoma area using dry sponges. 5.13 Ensures dryness of the area. Wet promotes
infection and irritation.
5.14 Clean an infected wound with an antiseptic 5.14 May help heal wound infection.
solution. A thin layer of antibiotic
ointment
may be applied to the stoma with a cotton
swab.
5.15 Change a disposable inner cannula, 5.15 Because cannula is dirty when
touching only the external position and lock it removed, use contaminated hand.
securely into place. If inner cannula is reusable, It is considered sterile once cleaned,
remove it with your contaminated hand and so handle it with sterile hand.
clean with hydrogen peroxide solution using
brush or pipe cleaners with the sterile hand.
When cleaned, drop it into sterile saline
solution and agitate it to rinse thoroughly with
sterile hand. Tap gently to dry.
5.16 Change tracheostomy tie tapes. Cut soiled 5.16 Stabilization of the tube helps
tape while holding tube securely with other prevent accidental dislodgement
hand, careful not to cut the pilot balloon tubing. and keeps irritation and coughing.
5.17 Remove old tapes carefully. Grasp slit end 5.17 To prevent discomfort, pressure and tissue
of clear tape and pull it through opening on side irritation.
of tracheostomy tube. Pull other end of tape
securely through the slit end of the tape. Repeat
on the other side then tie the tapes at the end of
the neck in a square knot. Alternate knot from
side to side each time tapes are changed.
5.17.1 Ties should be tight enough to keep tube 5.17.1 Excessive tightness of tapes will
securely in the stoma, but loose enough to compress jugular veins, decrease
permit two fingers to fit between the tapes and blood circulation to the skin
the neck. under the tape, and result in
discomfort for the patient.
NICU-179


5.18 Place a gauze pad between the stoma site 5.18 To absorb secretions and prevent irritation and
and the tracheostomy tube. Always keep the infection of the stoma.
area dry.
5.19 Cleaning of the fresh stoma should be 5.19 The area must be kept clean and dry to prevent
performed every 8 hours or more frequently if infection.
indicated by accumulation of secretions. Ties
should be changed frequently if soiled or wet.
5.20 Documentation:
atus of tracheostomy site.
Size of trach cannula
eaning provided & dressing change, including date
and time.
Color, amount, & consistency of
Secretions.
Tolerance to procedure.
6.0 ATTACHEMENTS
6.1 Nurses notes

Tracheostomy care kit
Sterile towel
Sterile gauze
Sterile cotton swabs
Sterile gloves
Hydrogen peroxide
Sterile water
Antiseptic solution & ointment (optional)
Tracheostomy tie tapes (commercially available)
Tracheostomy securing device
Face shield
8.0 REFERENCES
Lippincott Manual of Nursing Practice, 7th Edition by Nettin
NICU-180


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-181

TITLE: Breastfeeding, Assisting the Mother

1.0 PURPOSE
To aid new mothers in acquiring skills for successfully breastfeeding their infants.
To establish the nurse’s role for the promotion and support of breastfeeding
mothers and their infants who require specialized care in the NICU or Intensive Care Nursery.
To promote mother – infant bonding.
2.0 DEFINITION
None
3.0 POLICY
Mothers should be encouraged to breastfeed their infant as soon as feeding is ordered by
the physician.
Proper collection and storage of breast milk must be initiated.
Breast milk must remain at room temperature when infant is receiving continuous
feeds.
Breast pump set up and usage must be demonstrated to mother. Printed information
regarding breastfeeding must be provided.
Always use fresh milk first before going to frozen milk supply. Amount in excess of a
48 hour supply should be frozen for future use.
Do not thaw or heat milk in microwave.
Length of actual breastfeeding time should be limited only by infant’s tolerance.
Infants with special problems or concerns should be referred to a member of breastfeeding coordinator
for further counseling.
Breastfeeding card must be given to mother so that she can come to breastfeed her infant
anytime of the day.
NICU-182



5.1 Teach the mother about care of breast 5.1 Proper health teachings and information
and nipples must be provided to maintain a healthy procedure.
5.2 Prepare mother to receive baby. 5.2 To promote mother – infant bonding.
5.3 Wash hands. 5.3 To maintain cleanliness and prevent infection.
Teach mother different techniques and position of 5.4 Errors in glucose reading can result in
breastfeeding: miscallibrated of improperly coded meters.
Breastfeeding should be established within the first
hour of life.
Breastfed babies may be fed on demand.
Instruct proper latch on, getting much of areola
into mouth and nipple to back of the infant’s
mouth with lips “flanged’.
Instruct mother to burp the infant after
feeds, holding the infant upright
with gentle pressure against 5.4.4 To prevent aspiration.
stomach and patting or rubbing
back.
5.5 Instruct mothers on proper diet, to 5.5 Helps in establishing and maintaining an
increase fluid intake and to continue adequate supply of breast milk & promote
prenatal vitamins and iron as prescribed health of the mother and baby.
by physician.
5.6 Document condition of the breast and 5.6 To provide information on infant’s
nipples, and the response of the baby tolerance to procedure.
to breastfeeding.
COLLECTION & STORAGE OF BREAST MILK:
Instruct the mother to always wash hands
with soap and water before handling the
breast, the pump & attachments.
Instruct the mother how to set up the pump
equipment properly.
5.3 Instruct mother to begin milk expression
NICU-183


as soon as possible after birth, ideally in

the first few hours.
5.4 Instruct mother to collect milk in sterile 5.4 To maintain sterility of the breast milk thus
plastic containers provided in NICU. preventing complications that may occur.
5.4.1 Each milk container should be

labeled with mother’s full name,
date and time pumped.
5.4.2. Always use fresh milk first before 5.4.2 Amount in excess of 48 hour
going to frozen milk supply. supply should be frozen for future use.
STORAGE GUIDELINES FOR BREAST MILK:
Fresh 2 – 5 days in refrigerator
Thawed 24 hours in refrigerator
Frozen (home freezer unit) 3 – 6 months
Frozen (deep freeze 0 F) 6 – 12 months
6.0 ATTACHEMENTS
6.1 None

Breast milk
Feeding Bottle
Breast pump kit
8.0 REFERENCES
Neonatal Nursing Handbook by C. Kenner, J. W. Cott
Neonatology Management, Procedures on Call Problem, Diseases & Drugs 5th edition
by T. Gomella
Ministry of Health Policy and Procedure (CD) 1425
NICU-184


NAME: DATE

PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY:
NICU-185

TITLE: Availability of 24 Hour On Call Physician

1.0 PURPOSE
2.1 To facilitate prompt availability of on call physician at all times to provide immediate intervention in
emergency situation.
2.0 DEFINITION
None.
4.0 POLICY
Daily Rota of 24 hour on call Physician with pager number and/or mobile number
should be posted in NICU bulletin board.
Doctor’s room is provided to on call physician in NICU for easy access when
needed.
On call Physician should be contacted through pager bleeping system, mobile
number or through operator in case he/she is out of the area.

5.1 Head of the Department will prepare a
monthly Rota for the on call Physician.
5.2 NICU Nursing staff will be provided a
copy of the Physician’s Rota as a guide
for the 24 hour on call.
5.3 Head nurse / Charge nurse in NICU should
check the Physician's Rota daily then
write the on call physician including their
pager number and mobile number in the
bulletin board for easy access of the
nurses to contact when needed.
5.4 Nurses on duty will contact them through
the following:
5.4.1 Pager system by:
NICU-186

TITLE: Availability of 24 Hour On Call Physician

a. Press number 88 in the telephone.

b. Press the Physician's pager number.
c. Press the extension number of the
telephone you are using, then finally
press #, hang up the phone and wait for
the reply.
Operator by:
a. Dial extension number 2777, 0 or
2861.
b. Give Physician’s name to the
operator.
c. Inform the operator your location.
5.5 Document the time of calling and response
of the Physician in Nurses notes, and note
the time of arrival.
6.0 ATTACHEMENTS
6.1 Doctor's Monthly Rota.
None
8.0 REFERENCES
Ministry of Health Policy and Procedure (CD) 1425
NAME: DATE
PREPARED BY:
Mrs. Nada Harun
REVIEWED BY:
APPROVED BY: General Directorate Of Nursing- MOH.KSA 2010
NICU-187

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Ministry Of Health, General Directorate Of Nursing

Nursing Policies and Procedures’ Committee 2011

Dr. Munira Al Oseimy

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

SN POLICY TITLE INDEX NUMBER

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

Infants requiring hemodynamic monitoring: arterial, umbilical or central lines.

Follow P & P on Patient’s Admission and Discharge.

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

7.0 MATERIALS & EQUIPMENT

Mrs. Mary Ann Peralta

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

TITLE: Nursing Newborn Assessment

DUE FOR REVIEW: NUMBER OF PAGE: 1 of 4

5.0 PROCEDURES RATIONALE

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

TITLE: Nursing Newborn Assessment

DUE FOR REVIEW: NUMBER OF PAGE: 2 of 4

unsuspected disease, as well

5.5.6 Vital signs as well as blood

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

TITLE: Nursing Newborn Assessment

DUE FOR REVIEW: NUMBER OF PAGE: 3 of 4

7.0 MATERIALS & EQUIPMENT

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

TITLE: Nursing Newborn Assessment

DUE FOR REVIEW: NUMBER OF PAGE: 4 of 4

Mrs. Mary Ann Peralta

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

TITLE: Bathing an Infant Inside the Incubator

DUE FOR REVIEW: NUMBER OF PAGES 1 of 3

5.0 PROCEDURES RATIONALE

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

TITLE: Bathing an Infant Inside the Incubator

DUE FOR REVIEW: NUMBER OF PAGES 2 of 3

and the neck.

5.7 Clean the umbilical cord with alcohol

7.0 MATERIALS & EQUIPMENT

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

TITLE: Bathing an Infant Inside the Incubator

DUE FOR REVIEW: NUMBER OF PAGES 3 of 3

Mrs. Mary Ann Peralta

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

TITLE: Employee Surveillance in Neonatal Unit

DUE FOR REVIEW: NUMBER OF PAGES 1 of 3

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE

TITLE: Employee Surveillance in Neonatal Unit

DUE FOR REVIEW: NUMBER OF PAGES 2 of 3

5.0 PROCEDURES RATIONALE

7.0 MATERIALS & EQUIPMENT

SPECIALIZED NURSING: NEONATAL INTENSIVE CARE

INTERNAL POLICY AND PROCEDURE