PDA ligation

A Little Insight

Can you picture with me a sixteen month-old baby?  Most likely, they have recently tackled the art of walking.  Although they may be unsteady at times, they get from one place to another with determination and speed.  They have independence in their ambulating, no longer solely dependent on someone to pick them up and carry them. They may weeble, they may wobble, sometimes trip and stumble, but they know where they want to go and they teeter around until they get there. This is the picture of me, and how I felt this past week.  While I’ve developed as a NICU nurse and “found my feet,” I nevertheless felt somewhat wobbly walking into my assignment. The time we allot to report off from night shift to day shift was also utilized the other morning to set up for a common procedure on preemies; a PDA ligation.

Despite the confidence and competence I’ve gained over these last sixteen months, I had never been involved with, observed or cared for, a baby on a PDA ligation day.  Therefore, I expressed this to the cardiac coordinator.  Yes, it was humbling, and somewhat embarrassing, but I didn’t want there to be an assumption that I was well versed in my role for this procedure.  My personal pride, and her assumption of my expertise, was not worth an oversight.  And she was more than gracious in explaining what needed to be done in preparation, in addition to what I needed to do post op.

The procedure went smoothly and was completed in under an hour.  The rest of the day was not as smooth.  I titrated dopamine and gave a bolus of normal saline as ordered to maintain the baby’s mean blood pressure within set parameters.  I administered morphine and versed as ordered, and still found it troubling that I couldn’t get the baby’s heart rate out of the consistent 230s range.  I assisted in failed attempts to place a peripheral arterial line.  I reluctantly continued drawing CBGs and a repeatedly clotted CBC sample via heel sticks on my minimal handling protocol patient.  Ventilation changes to the conventional ventilator and JET were made in response to the result of some concerning cap gas results.

All throughout the day, I questioned myself as to what nursing intervention I should make.  I did everything I knew to do, and yet wasn’t getting the results I desired nor the assurance that I wasn’t missing something.  At one point, I asked one of our unit’s highly knowledgeable and respected transport nurses what she thought I should do.  She seemed hesitant to brainstorm with me, as she knew I had already inquired to one of the neonatologists.  I said, “Okay, listen NICU nurse of eight years, versus this one of sixteen months, I need some insight.”

And sometimes, that’s all we need.  We need a little insight.  The fact of the matter is, that baby’s circulatory system had made a big change, and the time of transition is bumpy.  It’s par for the course.  I showed up that day with the skill and knowledge to care for that baby, but I was just a little wobbly.  I knew where I was headed.  I knew the goal.  But I needed a little assistance and reassurance in getting there.

No matter where we are in our walk, or which walk we’re walking; whether it’s our walk with the Lord, our walk in our marriage, our walk as a parent, as a friend, as a professional; the fact is, sometimes we need a little insight, a little assistance, a little reassuranceSometimes we still need a little support.  Like those sixteen month old wobbly walking, yet focused and confidently independent new walkers, there are times that require us to reach up and grab a hold of a little help, even if it’s just a finger to hold.

Psalm 121:1-8 (NIV) 1 I lift up my eyes to the mountains—
where does my help come from? My help comes from the Lord, the Maker of heaven and earth. 3 He will not let your foot slip—
He who watches over you will not slumber; 4 indeed, he who watches over Israel
will neither slumber nor sleep. 5 The Lord watches over you—
the Lord is your shade at your right hand; 6 the sun will not harm you by day,
nor the moon by night. 7 The Lord will keep you from all harm—
He will watch over your life; 8 the Lord will watch over your coming and going 
both now and forevermore.

~~ a good video of a PDA ligation procedure ~~

caution: not everyone would enjoy watching


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