Thursday, November 26, 2009
ABG on neonate? Gobble! Gobble!
I always choose to work the Thanksgiving Holliday due to the fact it's usually not busy. Most doctors work overtime to send as many patients home as possible. Last night, however, was the exception to the rule. ER wasn't so bad except for the 10 EKGs, but OB gave me a challenge near the end of my shift.
We had an exceptionally nice rental neonatologist and she kept ordering things that not only were not indicated, but were not done where I work. Yet because she was so laid back I was able to cross the line a little bit.
Even though the pt had an SpO2 of 94%, the doctor wanted me to put 1lpm nc on the patient. She said that even though I already had the oxyhood set up. However, I said, "That patient has a sat of 94%, that's perfect!"
"Yeah, but I want it at least 95%."
Why? That goes against NRP recommendations.
"I would feel more comfortable just using the oxyhood," I said, "We don't have neonatal flowmeters here."
"Why not. This is neo ICU is it not?"
"Our neonatologists like oxyhoods. If you work here more often we'd set up any equipment you wanted." I smiled. What else was I to do.
She spent ten minutes putting in an art line, and by the time she was done I had a syringe for the ABG draw I didn't even think was indicated. But she said, "I don't want you to draw off this. I'm afraid it will clot off."
So why the heck did you put it in then?
"I want you do do a CBG," she said.
"We don't do CBGs here."
She grimaced. "Why not. Why you not have CBG equip? Why? You scared?"
"To be honest," I said, "Dr. Harry told me a few years back CBGs aren't beneficial." I bit my tongue due to the verbal slilppage of the tongue due to lack of sleep.
"That okay. Draw ABG then?"
"Why don't we just draw it from the line?"
"I don't want it to clot."
Since we never do those in OB, I had to go get a needle for the syringe I had in my hand. I had no intention of drawing it, though. In fact, I wasn't sure what I was going to do. Stall! Stall!
"You can draw it," I said to the doctor. "I bet you're pretty good."
She was palpating the radial pulse of the baby, so I thought she was going to do it. Then she handed me the syringe and, as she was walking away, said, "Just don't hit the central line."
By this time my relief showed up. I handed her the syringe, "Have fun!"
"I'm not dong it. I didn't even think you could draw ABGs on neonates. I never heard of it."
"That's my sentiments exactly."
"Happy Thanksgiving!" I said.