NICU: The Right Tools for the Job

Sandy Sundquist Beauman, MSN, RNC-NIC / June 2015


In many aspects of my life, having the right tool for the job has been helpful. My husband, a mechanic and general all-around fix-it man, often chides me for using a screwdriver to dig a small hole or a wrench to pound something. I enjoy doing all types of crafts too, and find that it is much easier if I have the right tool—not something that looks close and yet doesn’t really work the same. How much more important this is in patient care. Any nurse who has worked in neonatal care for many years remembers modifying devices or equipment to get the job done. The neonatal market place was quite new 35 years ago and care of very small infants progressed faster than manufacturing. Some may remember using a scalpel blade or large needle for heel sticks because proper lancets were not available. Or diapers held under warm water for heel warming rather than the commercially available heel-warmers. I have seen nasal suction devices created from tuberculin syringes and many others I won’t mention here!

Fast forward to 2015. Still, there are many places here in the U.S. who don’t have all the latest and proper equipment at hand when needed for specific patient populations. I remember working in one particular hospital a few years ago with a member of the team tasked with purchasing decisions where I was advocating for some equipment appropriate to the care of very small infants (generally less than 26 weeks). The manager of the team said that these items were such a low use item and took too much storage space so we could not bring them in. My response was that if we continued to accept and care for these infants, we had to have the product. Otherwise, we should send the infants to another facility where they had proper equipment to care for these infants. We got the supplies needed!

Hopefully, I may be able to provide you with some tips that might help you get the supplies you need to provide the best and safest care for these infants. Why are the supplies needed? This can be summarized into a few categories:

• Patient safety
• Provide standard of care
• Avoid off-label use of easily obtained supplies

Patient safety is a very broad category and should not be over-used as a reason to purchase supplies. However, with new guidelines and recommendations that create a safer environment, it is sometimes difficult to get those products available to the front-line team in the absence of your own incident. As the saying goes, we should not have to make every mistake ourselves but should learn from the mistakes of others. If it has happened somewhere else or to someone else, it could happen to you! For example, tubing misconnections. This is reported consistently, at relatively low numbers, but without doubt errors occur that are never publicly reported. And some may even occur that never get reported even internally because there is no bad effect from the incident; perhaps it is discovered quickly enough not to have any effect on the infant. Recommendations from the Joint Commission and other organizations are often helpful in making the transition.

A hospital would not think of opening a neonatal intensive care unit without proper monitors, incubators and ventilators. Other, often more frequently used supplies should also be available to provide the level of care expected from a NICU. There are many of these now! From the blended oxygen availability in the delivery room to plastic wraps for the extremely low birth weight infant to enteral only syringes and feeding tubes, proper equipment is critical in providing the accepted standard of care.

The use of supplies off-label has long been an issue in the NICU since proper equipment was not historically available. The examples I gave earlier are cases in point. However, as a rule today, this is no longer necessary. With rare exceptions, the proper equipment is commercially available. It’s just a matter of having it at the bedside when needed.

So, how do these issues get addressed at the proper levels in order to make a difference at the bedside? Most facilities have a Value Analysis Team, Return on Investment Team or similar. These groups usually handle decisions to purchase supplies and/or capital equipment purchases. Whatever these groups may be called at your facility, the NICU must have a voice on these teams. Being at the table is a huge part of the battle. While most hospital purchases are related to the adult population (unless a children’s hospital), the unique needs of the neonate must be addressed by someone knowledgeable in the clinical care of these infants. Having the ability to advocate properly and without too much drama is usually well-received.

Looking for more insight from Sandy?
Read her recent post, Benefits of Feeding Protocols.

Learn more about Medela enteral feeding Neonatal Solutions.


About the Author

Sandy Sundquist Beauman has over 30 years of experience in neonatal nursing. In addition to her clinical work, she is very active in the National Association of Neonatal Nurses, has authored or edited several journal articles and book chapters, and speaks nationally on a variety of neonatal topics. She currently works in a research capacity to improve healthcare for neonates. Sandy is also a clinical consultant with Medela. You can find more information about Sandy and her work and interests at