umcRN 19,965 Views
Joined: Nov 28, '10;
Posts: 872 (33% Liked)
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Our PICU does a lot of heart surgery, and its a challenge keeping up with the thousand-and-one ways you can be born with a jacked up heart. (I mean, we had a patient who had Transposition, dextrocardia AND heterotaxy - makes your head swim!)
Having said that - I like PICU the best of all three.
I have no experience with home vent training but as a NICU/Peds CICU nurse I ask that you PLEASE make sure you get adequate training and feel comfortable with the patient and their needs before taking them on your own. I have full respect for the nurses that choose to work private duty nursing for complex patients, god knows I don't think I could do it, but I love those kids and it breaks my heart when they come in coding because the home nurse was uncomfortable with the care they needed, didn't escalate in time or didn't react appropriately to an emergency situation. This could be form inadequate experience, inadequate training or an issue with the agency not assigning nurses appropriately. I have seen too many kiddos come back in coding and suffer devastating brain injuries after coding from a plugged trach.
And like another person said, definitely train with not only the nurse experienced already with the patient but also whoever the primary caregiver is. If it's a child the parents almost always know what is best and right for their child and can show you how they like to do trach care, trach changes etc. So long as it is safe I don't try to change techniques even when they are inpatient in the ICU
I don't work private duty but in my pcicu we have 24/7 cameras above every patient bed. They are used so codes and other serious safety events can go back and be reviewed and see if procedures (like rapid ecmo deploying) need adjusting. At first people were freaked out and upset by it, now we don't even realize it's there. Initially nurses were very afraid though of doctors using the cameras to "point fingers" at something the nurse did wrong. This hasn't been an issue of yet that I know of
I was working in the peds cardiac ICU one day taking care of this kiddo 1 day post op who really wasn't doing to hot. He was acidotic, hypotensive, having respiratory distress, just in general looked bad. We all though he'd be reintubated before lunch. Well it turns out he was not draining from his chest tubes well because the fluid was so thick so the docs on rounds tell me to aggressively milk his chest tubes, which I did roughly every 20 minutes, getting a good amount out.
After a while of this one of the attendings turns up to check on him, she is definitely one of those "I am holier than thou" types and asks me if she can take a turn milking his tubes which I gladly let her so I could get caught up on other stuff. Well when she realized how much was coming out she proceeded to milk the tubes for an hour and a half straight! Now, really if that is what she wanted, continuous tube milking, I could have done it, but he was obviously improving and the other nurses and I knew that she would keep at it just to be able to tell everyone how she "fixed" him.
The best part of all this, as she is going on to her colleagues about how amazing her handiwork has been, the kiddos parents turn up, they talk for a few minutes but then, not actually knowing who she is (she was a new attending for them), ask her if she was the charge nurse that day! The look on her face was priceless! And most of us nurses had to walk away for a minute to not crack up at that comment and watch her stutter in shock to tell them who she was.
Don't know of any good pocket books but check out survivalcards.com they sell small cards packed with info, mainly about meds but have some abg info, intubation info and vent info as well as general vitals for nicu, they also sell a nrp card and peds/pals cards. I have mine attached to my badge for quick reference
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