Chapter 25: Principles of Neonatal Procedures

I. 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.

II. STANDARD PRECAUTIONS

Standard precautions integrate and expand the elements of the previously adopted universal precautions and are designed to protect both healthcare workers and patients. Standard precautions apply to contact with all body fluids including blood, 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. Refer to your local unit policy manual for detailed guidance.

1. Standard precautions key components

   1. Hand hygiene before and after patient contact.

      1. Hand washing (40–60 seconds): Wet hands and apply soap; rub all surfaces; rinse hands and dry thoroughly with a single-use towel; use towel to turn off faucet.

      2. Hand rubbing (20–30 seconds): Apply enough product (alcohol-based products gels, rinses, foams) to cover all areas of the hands; rub hands until dry.

      3. Wearing gloves without correct hand hygiene can contaminate the gloves. Studies show that less direct patient care also occurs when clinicians wear gloves. A randomized trial found that wearing gloves after hand washing protects premies from infections. Infants <8 days old, <29 weeks, and <1000 g who were handled with nonsterile gloves after handwashing had less late-onset invasive infections, less necrotizing enterocolitis, less gram-positive infections, and less central line–associated bloodstream infections when compared to infants handled with hand washing only.

      4. Clean versus sterile gloves. The World Health Organization (WHO) recommends that clean gloves are to be worn prior to insertion of peripheral intravascular catheterization and that sterile gloves are to be worn for insertion of arterial, central, and midline catheters, when guidewire exchanges are performed. Wear either clean or sterile gloves when changing the dressing on intravascular catheters. Nonlatex gloves are recommended for contact with blood, body fluids, secretions, contaminated items, mucous membranes, and nonintact skin.

   2. Personal protective equipment (masks, goggles, and/or face masks). Assess the risk of exposure to body substances or contaminated surfaces before any healthcare activity when contact with blood and body fluids is likely. For facial protection (eyes, nose, and mouth), wear a surgical or procedure mask and eye protection (eye visor, goggles) or a face shield to protect mucous membranes of the eyes, nose, and mouth ...