Nurse Kelly’s Notes

11/12/2025

I’ve had TWO CBCs clot on babies in over 4 years, and it’s not because I’m lucky. Proper technique and good preparation are key in avoiding any NICU nurse’s most dreaded phone call from the lab. Share your tips and tricks to avoid having CBCs clot in the comments!

1. Put a heel warmer on your patient. Depending on my patient’s perfusion, I’ll sometimes add a second heel warmer and place it on the calf, or I’ll place the foot with heel warmer inside of a diaper.

2. Use gravity to assist you by angling the head of the bed UP, with the feet lower than the chest. I’ll swaddle or restrain my patient if necessary as well, to avoid being kicked during the procedure and to comfort them, and offer a pacifier or sucrose.

3. Use an appropriately sized lancet to puncture the skin on the outer aspect of the heel. You should never have to upsize your lancet to keep a specimen from clotting.

4. Work with gravity and the flow of blood, not against it. A common mistake that I see is that people will raise the head of the bed, but then they also inadvertently pull the patient’s leg up in the air, too.

5. Avoid scraping the specimen tube against the patient’s skin to avoid having skin cells mix in with my sample, which can cause clotting. Let big drops of blood fall into the tube without squeezing the lower extremity. The more scraping that you do, the more likely that you are to have your specimen clot. If bloodflow is slowing, pump the leg back and forth or briefly massage the calf.

6. The purple top tube that we use to collect CBCs has an additive called EDTA. EDTA is an anticoagulant, and it works by binding to calcium ions in the blood. EDTA inhibits the coagulation cascade, but it doesn’t affect cell counts. Overfilling and overshaking your tube actually increases the chances of hemolysis or clotting. Instead, gently invert your tube 8 to 10 times, end over end, to ensure that the EDTA mixes to prevent clotting.

11/08/2025

11/07/2025

Part 2 of a discussion about functional residual capacity, or FRC: Let’s talk about FRC with respect to respiratory distress syndrome, transient tachypnea of the newborn, and meconium aspiration syndrome. Personally, when I started in the NICU it took me a while to understand why we manage MAS with lower PEEP and higher set rates, so I spent a little extra time talking about that!

11/04/2025

Let’s review functional residual capacity — known as FRC for short — and do a brief overview of what it means for our babies in the NICU! There are a lot of different reasons why our patients present with respiratory issues, but hopefully by the end of this video you’ll understand the role that FRC (or lack thereof) has in the signs and symptoms that our patients exhibit!

I have so much respect for our respiratory therapists because one of the concepts that I struggled with the most upon becoming a NICU nurse was the lungs — and I’m still learning! Hopefully this video makes things easier for you to understand, too. Make sure that you’re following me to watch when the second part of this series drops!

11/04/2025

Some pointers on mechanical ventilation and newborns…
🤍 Monitor the insertion depth of your patient’s ETT at the gum! The 9th edition of NRP specifies the gum as the landmark for measurement now. I actually will check my patient’s ETT during hand-off with the offgoing nurse.
🤍 Ensure that the patient’s tape or securement device isn’t slipping or loose. If we can avoid an accidental extubation, that’s really the best.
🤍 Consider pre-oxygenating or giving manual breaths to your intubated patients before suctioning.

Signs that an infant is intubated include:
💜 Equal, bilateral breath sounds
💜 Color change on a CO2 detector (Note: in patients with poor perfusion, you may not see color change!)
💜 Air column or mist appearing in an ETT.

10/31/2025

Emergencies and codes in the NICU are inevitable. While we may not have control over how small, premature, or sick a patient is, we CAN control much of how we respond to a crisis.

What tips do you have for responding to neonatal codes and emergencies? Share in the comments so that we can grow in our practice together!

10/30/2025

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10/29/2025

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10/28/2025

Let’s chat about counterfeit car seats! I know we’ve been seeing an increase in counterfeit car seats in my NICU. To all of my NICU and Mother/Baby nurses out there, are you experiencing an increase, too? How are you units managing this and supporting parents? It can be tough to have a conversation with them about a counterfeit car seat, as necessary as it is!

I’m not a CPST, but I’ve identified counterfeit car seats by noticing:
1. A lack of warning labels on the seat
2. No length/weight minimum or maximum listed
3. Lack of a five-point harness
4. Lack of a chest clip
5. Lack of a manufacturer listed

10/22/2025

This may be an unpopular opinion but, generally speaking, families shouldn’t be asked to leave or step out if their baby is experiencing a medical emergency. It erodes trust in the healthcare team.