[warber]

I want to borrow from your expertise a question about PICU. As we are opening our new PICU in the near future I was asked to prepare a sort of curriculum of topics / competencies that nurses should be familiar with when working in one.

The American Association of Critical Care lists the usual things - compromised airways/ventilators/advanced airway sorts of thing, hemodynamics, cardiac/electrical topics, etc - for becoming certified in Pediatric Critical Care, but I was wondering if there were anything else considered core subjects?

I think we are looking at a 2-day affair for all the nurses going to work in the new unit. We have hired some with experience but that, of course, will vary and we want to start them all on the same page as they start work together.

Would appreciate what you can share; any web links you know of would help as well

Thanks

[janfrn]

One thing you might want to consider including is the safe handling of cytotoxics, especially if your unit will be recovering transplants. Most transplant recipients will be on at least a couple of cytotoxic drugs, mycophenolate mofetil and gancyclovir (for CMV/EBV mismatch or reactivation). Patients who received their transplants a decade or more ago who come in with sepsis, rejection or failure from some other reason might be on azathioprine. There is also a statistically significant increase int he number of oncology patients being admitted to PICU, whose chemotherapy will usually be given by the oncology staff, but their excreta will be cytotoxic. These drugs require special handling, and our unit includes a review each year in our annual recertifications. Your pharmacy should be able to help with that.

You might also look at the three main methods of dialysis: peritoneal, continuous venovenous hemofiltration and hemodialysis. The use of CVVHD is becoming more and more common as an adjunct in septic shock, as well as for renal failure with hemodynamic instability. We currently have two patients on CVVHD for hepatorenal syndrome and hemolytic uremic syndrome; last week we had an ECMO patient and a Berlin heart patient on as well. You wouldn't need to go into great detail, mainly an overview of the types, how they work and the risks, benefits and nursing care for each. We do a lot of manual PD in our unit, typically on post-op cardiac patients; it's simple but time consuming.

It's very exciting to be opening a new unit. I wish you smooth sailing!

[AliRae]

We have an 8 week PICU course that runs once a year. I'm late right now (I wish allnurses wasn't so dang addicting!) but when I get home tonight I'll grab my binder and jot down a list of the topics.

[kcangel]

The nurses need to know their drugs. Huge! Sedation meds, antibiotics, vasopressors, pain meds just to name a few. All of our nurses are required to take PALS. Trachs, art lines, central lines. Disease processes. If I can find some of our educational stuff I'll let you know.
Angela

[kessadawn]

The critical care classes at our hospital also cover death and dying, and ethics.

[ABE]

A new unit, that's exciting!
Don't forget fluid management, pediatric dosages, titrations, nutritional requirements of the critical ill child, normal growth & development, age appropriate neuro assessment and pain & sedation scales.
And don't forget family centred care, including families as full partners in care.
And bereavement follow-up care.
And how about care for the caregiver, don't want those new staff to be without coping skills for a rewarding but stressful job!
Best Of Luck!
Let us know how it goes...