Landed my dream job in Pedi CICU...now what?

~PedsRN~, BSN, RN · Jul 20, 2015

No words of advice, I hate the heart - LOL -

BUT CONGRATS!

Pediatric Critical Care Columnist · Jul 20, 2015

What great news!! There are some similarities in post-op care for kids and adults in terms of the sternotomy, chest tubes, infusions and so on. Differences in things like circulation, oxygenation (sats in the 80s might be too HIGH), metabolism and response to CPR are likely new to you though. And of course, the developmental part will take some getting used to. But I know you'll be just fine!

Review fetal circulation; it will be important in understanding how neonates are cared for pre-op. There are some excellent interactive diagrams here that relate to various cardiac defects. Although the information is addressed to parents, seeing the normal and the abnormal side-by-side is incredibly helpful. By knowing what the defect looks like pre-op, one can more easily predict potential issues that will arise in the first day or two and planning for them may commence. An example... coarctation of the aorta (severe stenosis) causes poor peripheral perfusion especially to the lower limbs pre-op. Once repaired, there's nothing impeding the flow of blood out of the heart any more but the heart hasn't gotten the message yet. So it keeps pumping away as if the obstruction were still there. BPs f 140/90 are not uncommon in even the smallest neonate following a coarct repair, so afterload must be controlled to prevent all those lovely minuscule sutures from ripping loose. Sodium nitroprusside is your friend! Transposition of the great arteries is corrected with an arterial switch and is treated similarly to your post-op CABG because the coronary arteries have been relocated to the correct ventricle along with the aorta and pulmonary arteries. Those tiny vessels need to be patent for the myocardium to have blood flow. So think nitroglycerin. Knowing where the blood is going both inside and outside the heart - pre- and post-op - is key to understanding the care plan.

Once you've had some time on the unit to get comfortable with both peds and the differences in admitting diagnoses you might be interested in some fetal/perinatal cardiology references. An excellent choice is The Perinatal Cardiology Handbook, available through Amazon or AACN. One of the authors is a consultant on my unit and loves to help new-to-PCICU nurses understand what's going on with their patients.

You'll start off with the kids whose repairs are relatively simple, the ASD or VSD closures, PDA ligations, BT shunts and coarct repairs. A lot of these kids come back extubated and are out of the ICU within a day or two. That'll let you get used to routine CV post-op care of children. Given that you have an adult CVICU background, you'll probably advance faster than the average, no-CV-expereince nurse would. If you remember to ask questions and not fear being thought stupid (you aren't, your expertise is in another area) you'll be just fine. Again, welcome to my world!

procrastinator911, BSN, RN · Jul 21, 2015

Congratulations! I am in the same boat as you , except without the CV experience. I start in 2 weeks. NotReady4PrimeTime is a awesome and has endless knowledge. Search in allnurses under peds cvicu/cticu and there should be some good info, especially from NotReady4PrimeTime!!! Good luck.