To Clamp or Not to Clamp...

Module Two

In recent months I have cared for a number of patients who have requested that the physician not clamp or cut their baby’s umbilical cord until it stopped “pulsating.” I used PubMed to search full text articles to determine if their were any maternal or fetal complications from delayed cord clamping/cutting. I was able to narrow my search in PubMed to include only randomized control trails and articles which were published in the last ten years. PubMed was also useful because it allowed me to use MeSH terms to help narrow my search. I used the MeSH term search feature in PubMed and was surprised to find out that clamping was the same as the MeSH term constricting.

When I initially searched the NCG guidelines for delayed cord clamping I was unable to find any guidelines. I tried a second time broadening my search to just “cord clamping” and was surprised to find only one guideline. Interestingly, the recommendation was labeled as a weak recommendation with low quality of evidence.

Searching Google produced a variety of information. There were multiple websites that talked about the benefits of delayed cord clamping and many that were very strange stating that you should not clamp or cut the cord until the placenta had detached. I even found a YouTube video produced by a physician talking about delayed cord clamping. Much of the information found by performing a quick Google search fits into the category “propaganda” and is unreliable because it is very slanted towards delayed cord clamping. Google scholar would be a more reliable search mechanism to finding research articles.

After performing my searches I was surprised to find that the majority of reliable information finds that delayed cord clamping is beneficial to the baby and is not harmful to the mother. Specifically, delayed cord clamping is associated with improved hemoglobin levels in infants up to six months old. I have to admit that I have been a skeptic of delayed cord clamping, however after reading multiple articles about its benefits I am beginning to change my tune. Now keep in mind that the articles only recommend delaying clamping the cord for about two minutes after delivery (not until the cord has stopped pulsating) and do not recommend it if the baby is very lethargic or appears compromised. I was so surprised by the wealth of information I found that I am going to pass on some articles to the nurse educator on our unit!

Getting to Know You...

Module One

My name is Stacy. I am known by many different titles: daughter, mother, sister, aunt, niece, dog walker, runner, nurse, but for the purpose of this blog my title is student. I am in a Family Nurse Practitioner Doctor of Nursing Practice program. This is my third semester and look forward with excitement and anticipation to graduating in Spring 2012.

I have been a Registered Nurse for six years and have worked the entire time in Labor and Delivery. I love my job and have become quite skilled at feeding patients ice chips while laying down, holding emesis basins, taking family pictures, and occasionally delivering babies.

Here are some interesting facts about me that you may not have known:

1. I come from a family of four girls.
2. I have three boys.
3. I bowled in a youth bowling league until I was in the 7th grade.
4. I have a “champion” line bulldog.

5. I enjoy running. This summer I am attempting what I have affectionately coined “The Triple Crown” which is three half marathons in six weeks.
6. In my spare time (which is none) I sew.
7. I hate cooking. When my sister asked me for recipes for the family cook book I sent her all my take out menus.
8. I love reality TV. My favorite summer reality shows starts up in a few weeks...Bring on the Big Balls!!

Why do you as a graduate level nurse need to know about information management?

Lets face it computers are not going anywhere. More and more hospital and clinics are using electronic medical records. Graduate level nurses need to know how to access electronic information about their patients. Technological advances are helping nurses utilize and synthesis data more easily which translates to being able to spend more time at the bedside. I noticed in the reading that there was a strong emphasis on evidence based medicine. Graduate level nurses need to know how to access electronic databases and utilize the latests evidence in their practices.

Describe what is happening related to IT in your clinical or practice setting.

Our unit has also recently implemented a Fetal Heart Tone Remote Monitoring Program. Nurses on my unit use computers to remotely monitor fetal heart tones in rural or small Intermountain hospitals. The goal is to improve maternal and fetal outcomes by having an extra set of “eyes” watching the electronic fetal heart tones for any signs of maternal or fetal distress. This program started as a pilot study last years and showed promise in reducing complications. The program was implemented full scale this month through out several Utah and Idaho Intermountain facilities.

Lost...

About Lost. There are very few shows that I watch religiously. Lost happened to be one of them. I watched from the beginning. The first three seasons were intriguing. The next three were frustrating (glad I have TiVo).

Even in its "bad" times I still watched. Every...single...episode. In total I have spent approximately 125 hours watching Lost. That's five days, five days of my life that I will never get back. Was it worth it... Maybe.

Now that it has ended I still have tons of unanswered questions. I guess that was the point. The writers of the show left the ending open to interpretation, letting the viewer decide what was really going on. So here is my take on Lost in the form of a Tweet:

Hot people on plane. Plane crashes. Weird things happen. Hot people die. More hot people show up. Cycle continues. Everyone dies but still hot!

The final scene of the show was poignant and thought provoking. You see the wreckage of the plane on the beach, but no survivors. Were they all dead from the beginning. Was the show about lost souls of sorts; spirits in limbo, purgatory, trying to make it to heaven or hell? Who knows! All I know now is my schedule just cleared up on Tuesday nights so if anyone wants to do anything I'm available, until the next show comes along.

This is a test...

I've never done this before, so I'm trying out my blogging experience by telling you about the amazing lunch I had yesterday. I ate at the Red Iguana in downtown Salt Lake (check out their menu here).

I ordered the lunch special: Mango Mole Enchiladas. Mango Mole what's that? Let me tell you! It was sweet and spicy deliciousness. So good I wanted to lick the plate clean, but then that would not have been proper restaurant etiquette. My husband was jealous, drool was running down his chin the entire time as he watched me devour the enchiladas. He ordered flautas, and while good, they did not exceed the expectations of my Mango Mole Enchiladas.

So if the next time you are in Salt Lake and wondering where to score some delicious and authentic Mexican food I highly recommend the Red Iguana. And if the Mango Mole Enchiladas are the special for sure order them, just remember spicy in spicy out.