Principles of Neonatal Procedures

INFORMED CONSENT

Upon admission to the neonatal intensive care unit (NICU), most facilities provide a parental blanket or general informed consent for routine procedures performed on newborns (eg, phlebotomy, intravenous placement) and emergency procedures for life-threatening situations. For nonemergent invasive bedside procedures that may carry significant risk, parental or guardian permission should be obtained. Risks, benefits, and alternative procedures, if appropriate, should be discussed. Major surgical procedures require informed consent. Refer to your local unit policy manual for detailed guidance.

STANDARD PRECAUTIONS

Standard precautions integrate and expand the elements of the previously adopted universal precautions and are designed to protect both health care workers and patients. Standard precautions apply to contact with blood, all body fluids, secretions, and excretions except sweat, nonintact skin, and mucous membranes. Standard precautions must be used in the care of all patients, regardless of their infection status.

In the case of a known transmissible infection, additional precautions known as expanded or transmission-based precautions are recommended. These are used to interrupt the spread of diseases that are transmitted by airborne, droplet, or contact transmission. Most bedside procedures incorporate principles of standard precautions.

Standard Precautions Key Components

• Hand hygiene before and after patient contact.

• Gloves for contact with blood, body fluids, secretion, contaminated items, mucous membranes, and nonintact skin.

• Personal protection equipment (masks, goggles, face masks) when contact with blood and body fluids is likely.

• Gowns for blood or body fluid contact and to prevent soiling of clothing.

• Sharps precautions. Avoid recapping used needles; avoid bending, breaking, or manipulating used needles by hand; and place used sharps in puncture-resistant containers. Use self-shielding needle devices whenever possible.

Time Out

JCAHO (Joint Commission on Accreditation of Health Care Organizations) has produced a universal protocol for “The Prevention of Wrong Site, Wrong Procedure and Wrong Person Surgery.” The 3 principal components of the Universal Protocol include a preprocedure verification, site marking, and a time out. Originally developed for the operating room, many facilities use this before bedside invasive procedures. All activity ceases, a moment will be taken (“time out”), and the following will be verified verbally by each member of the team:

• Correct patient identity

• Correct side and site

• Agreement on the procedure to be done

• Correct patient position

• Availability of correct equipment and/or special requirements

NICU PROCEDURE CONSIDERATIONS

Latex Allergy

There is a growing concern over latex exposure in the hospital. Certain pediatric populations are at higher risk for latex allergies such as in spina bifida. Many hospitals are converting to a latex-free environment. Latex-free equipment is recommended when available in the NICU.

Hand Hygiene

Hand hygiene is the most effective method of decreasing health care–related infections. It is ...