Nurse Kelly’s Notes

11/26/2025

Tips and tricks for IV insertion in the NICU! Taking the time to set up and prepare your patient is integral in increasing your chances for success!

First, I set up all of my supplies before doing ANYTHING to my patient. Regardless of whether or not I can visualize a site with the naked eye, I’ll use my to further assess. I love that my Firefly is wireless, rechargeable, and has multiple light intensity settings. It’s also got a studded surface to facilitate having a good hold on the patient to prevent veins from rolling.

Other tips and tricks:
✨ I don’t hesitate to use a heel warmer on the extremity of my choosing, especially if perfusion is poor or the extremity is cold.

If you haven’t invested in a Firefly to enhance your IV insertion skills, you absolutely should and now is a great time to do it! You can use code NurseKelly to take 10% off your purchase. AND starting this Thursday, you can bundle and save Firefly and Nurse Kelly’s Notes products for Black Friday, saving up to 20%. Stay tuned for more information!

11/18/2025

Managing pneumothoraces and chest tubes can be daunting for ANY NICU nurse, especially new RNs! Luckily, the Neonatal Intensive Care Nursing Bundle has the information that you NEED to boost your knowledge and confidence about caring for patients with a pneumothorax and chest tubes — it includes pathophysiology, evidence-based interventions, and rationales for over 70 commonly seen conditions affecting babies in the NICU!

Get yours by tapping the photo here, or shop on my website or Etsy at my link in bio!

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!