[SheaTabRN]

Hello all!

I just did a 13 week orientation in the NICU and found that it was (sadly) not a match for me. Not the actual NICU or the constant stress. Better to admit it now than wait I think.

I am thinking that I might apply in the infant/toddler area of pediatrics within the same hospital. Does anyone have any special insight about this area? I adore babies and working with them for me was completely natural.... and one of the most rewarding things I have ever done. Leaving the NICU is so very bittersweet.

I wonder about starting IV's on toddlers... How does one do this?? I know that some of our big babies required a second hand because they were so strong! Is sedation ordered usually?? Any suggestions as to how to calm one enough to do place an IV or other procedures... like: urinary caths, NGT, etc?

The Neofax was the NICU med bible... what do they use on peds floors??

Thanks in advance!

Tab

[BarbPick]

What a nice post to answer.
two schools of thought about whether to do Peds right after graduation.
Old Wisdom says everyone should do one year of adult med surg to learn organization skills and handle crisis that comes up
OR
Do a rotating Peds internship in a children's hospital and see where you fit.
In this situation, I will go against my usual advice and say do a Peds internship and learn all about children. Learn how to calculate small dosages from the start.

Now IV therapy:

To steal a line kinda from Hillary Clinton..It takes a village...to hold a child. It usually take 3 to 4 nurses to start an IV. It is always done in a treatment room because a child must always feel safe in their bed. Papoose boards are sometimes used, they come from the Hannibal Lector school of restraint, but sometimes are the only way to go. The approach coincides with age specific care, stages of development. Any specific questions you might have, PM me.
Barbara

[SheaTabRN]

Thanks Barbara!

Tab

[NicuNsg]

I wish you all the luck in the world!!!!

FYI: Harriett Lang is the med bible in peds...

Hope you find the peds unit is a fit for you!

[twinRN04]

hey there,
when i did my pediatric rotation this semester they had a topical anesthetic called EMLA cream that the Drs ordered prn so it was available for IV starts. You put it on and wait 45 minutes for it to numb the site then start the IV...i was never around to see how well it worked...but it's got to be better than 4 people holding down a kid....

[NicuNsg]

We use EMLA cream as well as cold spray. Not all children need 4 people to hold down, but some do require diversion...depending on age, could be a book or bubbles. EMLA cream and cold spray are great things, so thankful to have them. Thing to bear in mind is that just because you are numbing the area does not by any means mean they will remain still. Anxiety plays a huge role, especially if they had a lengthy ER visit before transfer (IV infiltrated) or have never been in the hospital. Some kiddo's do great though and are far more brave than I would be (tis better to give than recieve, LOL)
I guess the thing to take from this is assess the anxiety, EMLA and cold spray only lessen the anxiety, let the child maintain some sort of control (not whether to insert the IV or not, but what activity they can do to detour them while it is being done).

[vemiliob]

Hi, tab!

I work in a half general adult and half maternity-pediatric clinic. We’ve a different meaning for that word. To be more precise I’d say a clinic here is 15% doctor’s offices and 85% hospital settings, only on the private area. Most of our pediatric population (Pts.) is infant/toddlers between a month and 4-5 years, most of them between one months and two years old.

Before that, I’d some experience at ER and on Ambulances as pediatricians’ assistant. Doctors Do not help, they just give orders. In the ambulance team, one is back alone, drivers and docs seat on front. Sometimes when the child is alone he/she is very cooperative. I remember myself weeping a pair of times confronting the acceptance and maturity of those little kids.
We’re passing through a medium class crisis, after the last Argentinean default. One had and has to support too many pictures like children fainting at school because they weren’t eating since who knows when?
Or siblings together in the same school cared by the oldest one (sometimes a girl of 9 to 11) while their mother or father where at work to make money to nourish them.

What I want say is that most of the time you do it alone: to start an IV, to assist a child in convulsions or whatever.

When I rotate through the maternal-pediatric area (in my actual job) I have to start an IV with almost every new toddler getting in. I personally prefer a toddler than a preschooler. I used to ask the mother for assistance and if the infant is too aggressive (generally boys but sometimes girls too) I ask some co-worker to help me holding the infant. We have also a special room just to perform IVs, well illuminated with special settings to hold the toddler if necessary. No sedation orders. Just calm and you will see what is necessary. Don’t get in panic, angels will lead you. You’re just another god’s instrument. Things will happen through you.

I love everyone in the neonatology-pediatric area. Doctors Nurses and Parents work as real team. Everyone here has a tremendous vocation of service. Humility is the exact definition. Everybody here shows a natural warm humility and compassion for children.
Just jump in, I’m sure it’ll make you happy, and please keep us updated of your progress.