Newborn Transport A Closer Look

Author: Patricia Muncey RNC, BSNUpdated presentation: Susan Greenleaf RNC, BSN

Objectives:

Discuss what happens when the transport team is called

Identify what the referring units need to have ready for the transport team

Understand what goes on when the transport team arrives

Discuss how to help the parents when their infant is transported

The TGH Neonatal Transport Service – Who Are We?

Regional center for high risk OB and Neonatal servicesCoverage area

Southwest WashingtonGround-only transport

Team compositionTransport Medical DirectorRNC, RRT, and EMT The occasional visitor

Who Are We …..

Statistics

Consultation vs. Referral

What Happens When the NTS is Activated

Physician to Physician Consultation vs. Referral

Need for delivery attendance?

Charge Nurse to Charge NurseBed space

Staffing considerations

Reasons for deferring to Seattle

What Happens…..

Team ResponseTo TGH within 30 minutes

Leave TGH within 45 minutes

Rural Metro and our Rig

When the NTS Arrives

Our approachFirst priority is always the patient

Teaching opportunities may need to wait

QA process…

Plan of care dictated by patient statusTeamwork is everything

Timing is everything

Collaboration is everything

S = Sugar

NPO – if it’s too sick to stay, it’s too sick to eat

Risk of aspiration

Poor intestinal perfusion

Increased energy demands & consumption

IV AccessD10W @ 80ml/kg/day

Bolus 2ml/kg

Indications for UAC/UVC

T = Temperature

Heat loss – the famous 4Conduction, convection, evaporation, radiation

Those at greatest risk

Detrimental effects of cold stressAcidosis

Increased metabolic rate

Increased O2 consumption

Process for re-warming

A = Artificial Breathing

Please place me prone!

Indications for NCPAP

Indications for intubationProper ET size is everyone’s responsibility

Proper placement is everyone’s responsibility

Use of sedation

B = Blood Pressure

Causes of hypotensionHypovolemiaCardiogenic or Septic shockPrematurity

Diagnosis – history, S/S, labworkTreatment

Volume expansionBlood Vasopressor

L = Lab Work

Minimum:Blood culture (before antibiotics)

CBC with diff

Blood gas

Blood sugar

Any & all prenatal lab work on mom

HIPAA concerns

E = Emotional Support

Accompany the team to the parent’s room

Help clarify team explanations

Ask the team to identify TGH personnel if possible

Ask the family if you can call support people for them

Take pictures of infant

E = Emotional Support…

Call infant by first name

Offer follow-up call on arrival at TGH

Find out if mother is planning on breastfeeding

What We Need from You

Prenatal InformationMaternal prenatal lab work

Prenatal history

Delivery InformationResuscitation efforts

NRP!

Newborn care

Physician summary

What We Need….

All newborn lab & blood gas resultsBlood culture to TGH?No longer take maternal blood

X-raysCopies of all x-rays

Validates or clarifies diagnosisVerification of our ETT and CL placementDecreases exposure to radiation

Breast Milk on ice

What We Need…

Admit meds given?

PKU and Hep B vaccine?

And on behalf of our EMTs……At least 2 face sheets please!

QA Process and Education

Summary to TGH physician before departingWhat triggers a QA memo

Clinical concernsLow pH, low temp, intubation in route, resuscitation in route, expiration

Equipment failure or not availableCommunication concernsEducation need

And Last But Not Least….

THANK YOU

THANK YOU

THANK YOU

We wouldn’t have such great patient outcomes without you!

References

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