Curious About Pediatric Surgery

jdsmom, RN · Nov 13, 2013

Hello,

I have worked in the OR for 2 1/2 years with all peds experience. I had worked with adults prior only in telemetry. If peds interests you, I would say start by reading some on developmental stages and how they apply to O.R. experience, anything you can in pediatric surgery, and memorize vital sign ranges for the different peds ages.

Peds is going to involve a lot of appendectomies, cholecystectomies, hernia repairs, orchiopexies, cystos, hypospadius repairs, circumcisions, bronchoscopy for foreign body removal, I & Ds of abscesses and wounds, broken bones, and shunts, crani's and cranial reconstruction if you have neuro at your facility. Plastics will have cleft palate repairs, lac repairs (dog bites), and reconstructive surgery. Of course, tonsils and ear tubes are also frequent. That is the majority of what we see. The bigger cases are going to be neonates (preemies and full-term) with serious anomalies that require ex laps, bowel resections, crani's, PDA ligation, broviacs, laryngoscopies and bronchoscopies for respiratory problems or GERD. Some of the bigger cases I have seen are ureteral reimplants, crani for tumor resection, lobectomy, Nissen fundoplication, liver resection, total lung resection, cranial reconstruction for synostosis, Roux-en-Y, colectomy with pull through, spinal fusions, laminectomy with tethered cord release, and I am sure more, but can't think of any.

The biggest thing physically is airway and reserve. The smaller kids, less than 5 or so, don't have much reserve in terms of blood or oxygenation. The smaller they get, the less reserve they have. It would be a good thing to get PALS certified before going into a peds OR. Developmental considerations are the 2-year-old that won't let go of their mom or dad and you want to try and make the experience the least traumatizing as possible. You have to get creative with how you do things...I have seen anesthesiologists walk kids back to the O.R. holding their hands, trying to give them as much control over the experience without giving in too much. It is a fine balance. Some kids are just fine, but you have to prepared for the kids where their parent gives in to everything, so they will expect you will. Kicking, screaming, punching, biting, yelling at you. You distract, distract, distract, stay calm, and sometimes have to really hold them down while they go through mask induction. That is the other thing. They typically don't start IV's in kids less than 10 years if they are not already in the hospital. That means you have to be prepared to get an IV fast if the kid goes into bronchospasm or laryngospasm on induction. Good IV skills are a major plus. Imagine trying to get IV access on a 1-2 kg baby...not easy!

I will say, I absolutely love it! OR is rewarding, but peds OR is very rewarding. You can really make a difference for some of these kids and their families. I look forward to going to work every day and have a great time there. Peds surgeons and anesthesiologists are typically pretty easy-going, but they need to know that you can take care of a peds patient, especially if things go south.

If you want to go into peds OR, start looking for opportunities now, the best thing to help you is experience! Good luck!

Stacey30 · Nov 19, 2013

I work at a level 1 pediatric hospital OR (first nursing job out of school) and I love it. jdsmom pretty much covered the jist of the procedures we see except we also have opthalmology in my OR so we do lots of eye exams under anesthesia, eye muscle (strabismus), cataracts and cornea transplants. Traumas can be tough to handle, especially when the patient doesn't make it, I will warn you of that. But I can tell you that I work with a lot of nurses who came from adult ORs and they've never looked back!