Adult ICU to PICU??

Specialties PICU

Published

  • by llbCCRN
    Specializes in ICU, PICU.

Hi all!! I've been an adult ICU nurse for about 3 years and I'm looking for a change. I'm bored of the same old same with adults. I've always seen myself as a pediatric RN and I miss caring for kids! Just something about them that makes your job worthwhile!! Just wondering if anyone could provide insight on the transition from adult critical care to PICU. I am well aware I will be getting into an entirely different field!

Specializes in NICU, ICU, PICU, Academia.

Totally doable. I work with a couple of nurses from 'the other side' - they made the transition fairly easily and would not go back.

The major differences are 1) the diagnoses 2) how kids code (very different from adults) and 3) weight-based dosing for everything.

I've done both and would NEVER go back to an adult ICU.

llbCCRN

39 Posts

Specializes in ICU, PICU.

Janfrn, thanks immensely for the list of other posts... I guess it's a fairly common question. I feel better about making the transition now...

Can anyone tell me what kind of orientation I should ask for? Not just weeks, but experiences? I was on another forum asking about NICU nursing and one of the nurses got to rotate through labor and delivery and postpartum to get her mind back into the groove of performing newborn assessments and whatnot. I would love something out of the box like that. The PICU I would be working in is a large unit with level I everything lol... Basically, they take the sickest of the sick and other hospitals around the state and bordering states send their really sick patients here...

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.

Does this unit have cardiac surgical patients? Ask to observe a sternal closure. If the hospital provides ECPR you should observe it in action. If you've never seen ICP monitoring established on the unit (EVD and catheter placement) ask about that. There will be a lot of novel activities on the unit but they're not predictable. If you tell your preceptor and CNE that you'd like opportunities to observe, they should keep that in mind.

llbCCRN

39 Posts

Specializes in ICU, PICU.
Does this unit have cardiac surgical patients? Ask to observe a sternal closure. If the hospital provides ECPR you should observe it in action. If you've never seen ICP monitoring established on the unit (EVD and catheter placement) ask about that. There will be a lot of novel activities on the unit but they're not predictable. If you tell your preceptor and CNE that you'd like opportunities to observe they should keep that in mind.[/quote']

They have a CVICU for fresh hearts and cardiothoracic surgeries. I'm not sure what ECPR is, is it like ECMO? Thanks for the recommendations! I have my interview Thursday afternoon :)

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.

ECPR is what we call a resus that ends with cannulation for ECMO. Our unit does it about twice, sometimes three times a month. Outcomes are generally acceptable - meaning a patient survives with a fair-to-good neurological outcome. The really good ones start moving within the first hour or so after initiating ECMO. The last ECPR event I was involved in the surgeon was looking at the fully-draped kid quite oddly and then said, "Could we have some more roc here? She's moving!" That was a first for me for sure. "She" did really well and was home within a couple of weeks.

llbCCRN

39 Posts

Specializes in ICU, PICU.
ECPR is what we call a resus that ends with cannulation for ECMO. Our unit does it about twice sometimes three times a month. Outcomes are generally acceptable - meaning a patient survives with a fair-to-good neurological outcome. The really good ones start moving within the first hour or so after initiating ECMO. The last ECPR event I was involved in the surgeon was looking at the fully-draped kid quite oddly and then said, "Could we have some more roc here? She's moving!" That was a first for me for sure. "She" did really well and was home within a couple of weeks.[/quote']

Ah-ha!! I looked it up! With adults at our hospital we utilize therapeutic induced hypothermia s/p cardiac arrest when still unconscious after rosc. I'll look forward to learning more about ECPR. I LOL'd about the patient moving and needing more roc... I guess that was a good sign? Glad to hear she made a good recovery :) I wonder how different the amount of time the brain is anoxic differs in neurologic damage in kids compared to adults... Like 10 minutes of anoxia fore an adult and you pretty much say goodbye to having a quality of life... Hypothermia still only works in some cases, as most I've seen have moderate to severe deficits even after hypothermia.

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.

We use moderate hypothermia for kids too, with a target temp of 32-34°C for 24 or 48 hours post ROSC, then a 0.5°C increase every 4 hours to thermoneutral. Sometimes we don't do it, for example, if the arrest was on our unit, and the patient had an art line so we could monitor effectiveness of CPR, we might not need it. We have a very good track record with in-house arrests.

Kids have amazingly plastic brains. They recover so much more functional capacity than adults under almost any circumstance. My own son had a thrombotic watershed stroke when he was 5 and wasn't expected to interact with his environment at all. But he has a great quality of life despite his disabilities. You've never met a happier person. So in peds, we tend to err on the side of recovery most of the time, and when we've been wrong.... well, that's where moral distress in peds critical care comes from. I wrote a series of articles here on the topic, if you're interested.

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