Any Peds cardiac intensive care nurses out there?

Pediatric Critical Care Columnist · Jul 23, 2008

Almost six years ago I moved from a general PICU to a PCICU (well mostly: about 2/3 of our patients are cardiac). One thing I did to prepare was to read the report on the Manitoba Pediatric Cardiac Inquest (http://www.pediatriccardiacinquest.mb.ca). It didn't start out as prep but turned into it when I realized how much information there was within it about cardiac defects, their repairs and what can go wrong. For the unaware, in 1994 the Winnipeg Children's Hospital (where I used to work, but 3 years after these events) had a new and rather green pediatric cardiothoracic surgeon. 12 infants and children died during or following surgery and the situation became the basis for the longest medical inquest in Canadian history. The report makes for frightening but enlightening reading. Of course, techniques have changed a lot since 1994 and so has the nursing care. Cincinnati Children's Hospital (http://www.cincinnatichildrens.org) has an excellent web site that has animated images of different defects and their repairs. You might also want to review the care and feeding of the intracardiac line, mediastinal chest tube, multiple lumen central line and open sternum. Look at a good drug resource on infusions for information on epinephrine, norepinephrine, sodium nitroprusside, amiodarone, milrinone, nitroglycerine, alprostadil and magnesium. Know the onset of effect of captopril. Brush up on your PALS, especially rhythms. And be prepared for some rocky days ahead, with a new program there will always be a hill to climb before things become comfortable. Good luck!

kessadawn, BSN, RN · Jul 24, 2008

as usual, jan is ready with great advice!! :yeah: :yeah::yeah:also remember this, you can have 5 different kids with the same cardiac defect and repair, and you'll see 5 different roads to recovery. these kids can decompansate so fast, always be on your toes, and good luck!

Pediatric Critical Care Columnist · Jul 24, 2008

kessadawn's almost totally correct. Actually there are no identical defects, only very similar ones...

There is definitely no care map that will fit most cardiac patients. Our surgeons do the most complex and creative repairs, even some that they've made up as they went along, and so we don't have many "typical" courses. We actually only have care-maps for simple ASD repair and simple VSD repair. The rest of the care plans are one part proactive, one part go-with-the-flow and eight parts reactive! I cringe whenever a newish nurse is preparing to receive her first CV patient from the OR and says, "It's just an ASD." Kiss of death. We've had "just an ASD" go on ECLS for Heaven's sake! A little respect goes a long way.

yulia.gendler · Jul 26, 2008

Hi! I'm PCIC nurse as well. Work at Schneider Children's Medical Center of Israel for almost 5 years. I'm very proud and satisfied with my work in this special unit with all the advanced equipment and professional staff. We have full range of operations for repair of congenital and acquired heart disorders from newborn up until age 18 (All kind of septum defects, Coarctation and more complicated disorders like Truncus Arteriosus, TGA, Hypoplastic Rt/Lt heart etc), heart and lung transplantations, operation of ECMO.. Over recent years, the Unit has conducted two-thirds of all cardiac surgeries in the country which amount to about 400 operations annually.

All the nursing staff has BA Nursing degree at least, most of them have Master degree plus extra Intensive Care course.

I already published a thread on my main interest wich is pain management in PCICU, maybe you could refer my to anyone who might be interested to join me in some international projects on these matter.