Adult change to peds ER help

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Joined this site for help with my change from Adult ER to Peds ER at an all peds hospital. I need someone to ask "dumb" questions. I am contract so I only had 4 orient days and their nurses tell me ask anything but I feel like an idiot at times. I have 3yrs adult ER and have been an RN for 8 years all adult. Now with the peds change I think these nurses think I don't know a thing, when I could run circles around them in the adult ER. Need some peds ER and PICU buddies to ask a bunch of questions. My first, can you hurt a male infant while straight cathing? They use those 8fr rigid predesigned kits and I know kids clamp down during a cath, but tonight I felt like I was going to go right through the kid into the rectum. Finally got it in when he took a deep breathe, but it took about 4 minutes...way to0 long to sit their digging around. The next kid, I used a 5fr soft feeding tube and it went right in...any suggestions. And please, I have other "silly" questions like this about buretrols and mixing your own meds. Oh and what is an CRP blood test for? They do this alot.

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Specializes in Nephrology, Cardiology, ER, ICU.

4 days orientation - they should be ashamed of themselves! Can you ask for more time? That is absolutely ridiculous. As to straight-cathing boys, I find that you have to have a papoose board or holders that are experienced. I also hold the member in a 90 degree angle in my non-dominant hand and then insert just through the meatus until I feel resistance (they are usually screamming). When they take a breath or pause, then I quickly (and gently) advance the cath until I get urine. Use plenty of lube and you should do fine. Good luck.

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Welcome to allnurses.com. Post moved to a more appropriate Forum.

Suebird :)

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Specializes in Emergency.

As far as the ridgid cath kit yes you can potentially cause damage just as you could on an adult male using too much force. If I recall correctly the 8fr kit is designed for quick cathing adult females. If I recall correctly they make a 5fr pedi kit that you should be using on all but the smallest kidos. (i will check tonight at work) If they dont stock that kit then the feeding tube is what I have used in the past.

CRP I didnt see being ordered alot at the last Peds ER i worked but typically we used it to determine bacerial vs viral infections. Actually we were using it more on adult chest pain pts- they were doing a study.

Rj

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Thanks for respond. I did let him take a breath but felt such resistance. Do you think its ok to use thos 8fr ?semi rigid? caths or should you use a flex feeding tube. Can you perf through to the colon? or is this not possible. The screaming didn't bother me, I just didn't know how much force you could use when you hit resistance a couple of times

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Thanks, I am just learning how to reply here. I will take your advice and use the flexi feeding tube. The rigid on is what i've used on adults as well and it just didn't feel right with the kid. I need to go with my knowledge and instinct, I'm just trying to do things the way they do them but I guess I did know better. Thanks. Let me know what you learn tonight.

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Specializes in Peds ER.

Welcome to peds! I don't ever use the rigid caths on boys. It could potentially cause damage and there is just too much maneuvering and, ouch! The 5/6 FR feeding tubes work better every single time. Sometimes an 8 FR, it just depends on the size and age of the patient. The rigid ones, however, do work much better in females than the feeding tubes do. The hard part with the iddy biddies is finding that little wink, but with practice it gets much easier. Good luck and feel free to ask away!

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Thank you, I will take your advice and it is what I was inclined to do...gotta trust my instincts. Do you put iv abx on kids? ie: claforan 250mg over 5 minutes diluted about 10cc ns. Some of the nurses here do that for many abx and I think they all need to go over at least 15 to 30 min.

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Specializes in Emergency.

Ok I checked last night and the 8fr cath kits are labeled for female use. The 5fr are labeled for peds/infants.

As far as antibiotics go, I give them over the same amount of time I would give them to an adult. The only thing I would even think about giving that fast would be Ancef/Kefzol- have given IV push in adults before.

Rj

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Thanks, I will look at the kit labels tomorrow night. Regardless I will use a soft 5 or 8 feeding tube on the boys. And as I suspected, I will run the abx over 20, 30 min to 1 hr. I need to double check a lot of what these nurses say is ok, many of them are new grads in the last 2 yrs and may not have all their facts correct, although the one who pushes the abx have been there 10 yrs. Like I said, I had a gut feeling that several things these nurses say is ok, I wouldn't do to an adult, so they can't be ok in kids. Morale: look it up in Harriet Lane or the drug book. Thanks a bunch.

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We use the CRP as an indication of inflammation in peds. I've recently seen it being used in adult cardio cases.

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That is the consesus I'm getting, Thanks. Hope your week is going well. What hrs do you work. I work 36/week. 1pm to 1am.

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