Child Restraint During Induction ?

Published

Wondering how the RN's hold a child still during induction. I've seen a couple of different ways. One way is the "smother" where you kind of throw yourself over the child and try to hold down their arms and legs if they are kicking and screaming. Another way I've seen is to place the child's arms under a blanket and hold the edges of the blanket down close to the child's body so they can't wiggle and grab the mask or pull out their IV. One of our Anesthesiologists is complaining about how we stop the child from wiggling where I work if we use the blanket technique. He is referring to some study that says it causes the child to be frustrated because they can't move their arms ? I thought it was the whole point so that the child can't grab the mask or pull out their IV ? So.. how do the rest of you hold down a wiggling screaming child when you are trying to mask induce ?

As a patient it is easy to see only one side of the issue just as it is for a parent who works in the OR. I have been in and out of hospitals most my life (not for a chronic disease but for injuries as a result of what I believe to be ADHD). I too have never had bad experiences with surgery and am quite relaxed about it. Within the same token; working in the OR has shown me that everyone is not the same. I have seen people be as relaxed as me and I have seen some totally freaking out, even have had some to cancel the case once they got to the OR. That is where patient assessment comes in, including the assessment of the family with the child. Even children have a varied type of personalities that can be benefited by a parent being there or some who would be best suited if the parents never left the pre-op area.

I personally do not believe that it is best either way, because policy or routine does not determine the child’s state of mental preparedness. I feel it should be done on a case by case basis. Yes, it would take more time but would truly be in the best interest of the child.

Just my personal opinion.

Up Vote Up Vote ×
Specializes in surgical, emergency.

The PO Versed is really nice, unless you get a doc that's too pushy and won't give it time to work!!:banghead:

Frankly, my favorite, is I guess what you are calling a smother technique, I would rather consider it a swaddle/bear hug technique.

I'll let them hold their bear, blanket or what-ever, right up against them (it keeps their hands busy, at least for a while) then I cover 'em with a big warm cotton blanket.

Then I just lean over them, talking to them all the time, (me or the anes. doc).

This, depending on the size of the child, effectively controls the entire body, except the head, which the anes. doc has control of.

Some of our docs have used Sevo. Saw a one breath induction once.

Very impressive.

Mike

Up Vote Up Vote ×

No parents in the OR... in >20 years of experience is the best policy. Did trial it once and the nurse in the room wound up with 2 patients, with the mom feeling lightheaded. I work nights now, and there is no one else around to bring the parents to the waiting room, even if it were the best situation.

I have found that a few soft words, distraction, and holding the child in a warm blanket goes miles in preventing the need for restraints. After a few breaths of inhalant, lay the child on the bed and do what needs to be done.

Up Vote Up Vote ×
No parents in the OR... in >20 years of experience is the best policy. Did trial it once and the nurse in the room wound up with 2 patients, with the mom feeling lightheaded. I work nights now, and there is no one else around to bring the parents to the waiting room, even if it were the best situation.

I have found that a few soft words, distraction, and holding the child in a warm blanket goes miles in preventing the need for restraints. After a few breaths of inhalant, lay the child on the bed and do what needs to be done.

After all the surgeries I have had it does not scare me anymore to go under anesthesia. There is of course always that little bit of an edge. The soft words and nurse holding my hand gets rid of those last few nerves. It makes me feel like there is AT LEAST one person in the OR who cares about what happens to me.

I know the doctor does, and that all the personnel in there should, and probably do. For the older children (in which I include myself even though I am now 20) I feel like it is a feeling that we can not control what is going to happen to our body. We are totally at the mercy of the people who are in the OR caring for us.

Up Vote Up Vote ×
Specializes in OR.

There are very good reasons why parents are not allowedin the OR during induction. Have you ever had to deal with a parent who got so upset during intubation that they picked up their already anesthetized child and ran out of the OR? Well, I have and it was not a fun time... NO parents in the OR. If you tell a child stories and let them share in the hooking up of the BP cuff and monitors, they are so much more willing to be induced. Children are always going to be scared when away from their parents, however, if you distract them, tell them silly stories, ask them questions...etc...they do calm down and not throw hissy fits.

No...the REASON they are kicking and screaming is because they are taken away from mommy and daddy and have a ton of people taking them into a strange place, surrounded by tons of activity, and they are trying to hold them down.

That scares a child to death!

If a parent is there, soothing them, holding them until the mask is in place, assuring them the mask isn't going to hurt them and to just breathe....to me, that sounds like alot less traumatic than anything you are describing.

Then once the child is asleep, the parent leaves and waits to be called to recovery, where the parent is again present so the child can see them first thing.

Also, when possible, arrange for a child to be taken into the OR so they can just see the room....alot less scary if they have seen it before.

Someone there needs to get more creative with the process.

Up Vote Up Vote ×
There are very good reasons why parents are not allowedin the OR during induction. Have you ever had to deal with a parent who got so upset during intubation that they picked up their already anesthetized child and ran out of the OR? Well, I have and it was not a fun time... NO parents in the OR. If you tell a child stories and let them share in the hooking up of the BP cuff and monitors, they are so much more willing to be induced. Children are always going to be scared when away from their parents, however, if you distract them, tell them silly stories, ask them questions...etc...they do calm down and not throw hissy fits.

Can't say that I have...and hope that I never do.

I wasn't suggesting that the parents stay for the entire induction or the surgery.

I did have the opportunity this summer (I'm a student) to observe 3 pediatric surgeries...1 infant and 2 preschoolers.

The hospital did let the parent come back, only one....but only until the child was groggy and unaware of their surroundings...and they were quickly removed right before the intubation...so the parent didn't have to see that.

Then the parent was brought back to recovery so he/she could see the parent when they woke up.

I've got a tough stomach, but watching an intubation on a child was hard, and I know that if I saw 1000 of them I couldn't watch it on my own children.

Up Vote Up Vote ×
Can't say that I have...and hope that I never do.

I wasn't suggesting that the parents stay for the entire induction or the surgery.

I did have the opportunity this summer (I'm a student) to observe 3 pediatric surgeries...1 infant and 2 preschoolers.

The hospital did let the parent come back, only one....but only until the child was groggy and unaware of their surroundings...and they were quickly removed right before the intubation...so the parent didn't have to see that.

Then the parent was brought back to recovery so he/she could see the parent when they woke up.

I've got a tough stomach, but watching an intubation on a child was hard, and I know that if I saw 1000 of them I couldn't watch it on my own children.

Well hopefully there's not a hospital stupid enough to let the parents stay in the room that long. IF they're allowed to come in for induction, parents are always out the door as soon as the child is induced - at that point, the reason for the parent being there no longer exists.

Up Vote Up Vote ×

OK, I skimmed through most of the posts but not all. This thread got lenghty fast! Used to be a peds nurse in community and regional hospitals as well as homecare. Then also an OR nurse in a community hospital. NEVER saw a kid as upset as some of you are describing and I have thrown people out of pedi rooms for making a kid half so excited.

All of our kids get Versed first and we have it well planned (timing)

Your rooms must be absolutely ready before a kid comes back. Not the time to make ANY clatter with instruments or see people hustling around.

Hvae a calm transport person bring the kids back. Everybody who must be invlved, meet the kid outside the room, masks off, get to know them a bit (takes very little time) Chat about the stuffy, toy or blanket they brought. Maybe use their stuffy to demonstrate the mask first.

Ease them to the bed or anesth. lap. Keep only people they've met around them. Talk quietly and move slowly... senses are a bit hazy and keen all at the same time in the Versed fog.

Show them the mask and balloon as mentioned. Show them how to blow it up. Show them the chest "stickers" before you put them on. Having some fun stickers helps, too.

Up Vote Up Vote ×

I wanted to add that I've worked in hospitals that have a pre-op class for kids and it's great. Get a box of goodies together and invite kids and their parents to come in for about an hour on a day before the class- a nurse leading the class explains what will happen the day they come in- you'll get a bracelet and wear a gown like this. We'll weigh you like the dr does and show them the BP cuff and pulse ox. Let them touch and play with everything. Show them an anesthesia mask and circuit and let them have an EKG "sticker" to play with and keep. Try to arrange a tour- show them an ASU room and meet a cheery nurse (LOL) We always tried to keep an OR room close to the OR desk open and clean on class evenings. Took parents and kiddies to the locker room to put on jump suits, booties, and OR hats. Kids can even wear left over open-unsterile gowns if they're carried. Then we show them a "real OR" The bed they'll nap on and the anesth. machine and desk. Maybe one kid will let you put on stickies to see their heartbeat on the monitor. Meet some friendly staff members. Show them PACU and let them pick a sticker or toy if your PACU keeps goodies. Point out to parents the points on surgery day where they will leave and be re-united with their kids.

Up Vote Up Vote ×
Specializes in Med/Surg,OR.

I was Pediatric Lead in a level one Hospital for 5.5 years. I think the question deserves multiple answers depending on the age of the child. For infants often the Anesthesiologist would cradle on his/her lap one arm around, the other holding the mask. Children 1yr to 3yr (depending on the size and weight of the child) I like the blanket method. And 3yr to 6yr (again depending on size/weight) usually I would place arms at their sides and lean over their torso holding them by their shoulders. I myself am not a very tall nor large person, but it usually worked well and did no harm.

I think letting the parent(s) in for induction is not a great idea. Anyone who deals with children and parents in the OR setting usually will agree that it's not the children that they have to worry about, it's the parent(s). My personal feeling is that is stresses the parent(s).

I'm sure others will disagree, but then, that's what opinions are for.:up:

Up Vote Up Vote ×
Specializes in OR - Telemetry - HBPC.

My speciality was ENT, so I had the opportunity to assist with many small children. When a child is "wild", there is really no other way than to use the smother technique (we called it the slam dunk). You have to take into account some children kick. pinch, bite, and scratch. They can actually injure the staff members if not controlled. I also noticed that most of the children that acted this way was the "boss" at home.

:scrm:

Up Vote Up Vote ×
Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.

I know it's an old thread but I had to reply. My preschool aged son was in the O.R. many times over the course of several years for intrathecal chemo. My husband or I was both allowed in the OR for induction, fully suited up and masked.

Of course we had tons of prep with a child life specialist and our own little OR set up at home that we reheorificed with and books to read about it etc. That I think is the most important, the family being prepared for the procedure before the pt gets there.

What worked for us was the anesthesiologists would meet with us pre-op and let the child pick out a chapstick flavor-- they had an assortment. When we got to the O.R. the docs or nurse would say, remember that chapstick you liked? The chapstick would then be rubbed on the inside of the gas mask, the docs would say, ok time to smell your chapstick, the gas would go on, the IV proprofol would go in and it worked like a charm. On our walk to the O.R it was our "joke time" and the O.R. staff, myself, and my son would tell jokes back and forth to lighten the mood. He never had to be pinned down in the O.R.

Up Vote Up Vote ×
+ Join the Discussion