New PICU nurse with questions!

tryingtohaveitall · Oct 10, 2012

Congratulations! Most of your questions are somewhat hospital/unit specific, so I'll answer for my hospital. Yes, I love my job. Generally I feel like I have the time to give great care to my patients but I would imagine everywhere there will be busy times when staffing is not ideal. As far as bedside procedures, you can expect to assist with a bit of everything: intubations, codes, line insertions (dialysis catheters, CVLs, PICCs, arterial), chest tubes, pericardial drains, TEEs, LPs, ___ centesis procedures. I'm sure there's more than I listed. As far as PIVs vs CVLs, that may depend on your unit. My unit tends to have a mix. Those kids who recently arrived, aren't all that sick but need PICU monitoring for a short period of time will only have PIVs. These kids tend to be DKAs, status asthmaticus, status epilepticus kids who are sleeping it off or may have gotten intubated and we're waiting on them to wake, etc. Those who come in significantly ill usually receive a CVL right off the bat. Those who start out with a PIV and then it looks like they're going to need more stable long term access will usually get a PICC. Some of these kinds of kids are severe pneumonias, meningitis, shunt infections, etc.

Hope this helps and good luck!

Double-Helix, BSN, RN · Oct 12, 2012

What kind of procedures I should expect to be a part of at the bedside? What kind of things will I have to help the doctors with?

It's so hard to give a comprehensive list here. There can be a huge variety of bedside procedures in PICU. Most commonly: intubation/extubation, central line placement/removal, arterial line placement, biopsy and needle aspiration, spinal taps, chest tube placement/removal, suturing/suture removal, and drain removal. That's all I can think of off the top of my head, but I'm sure I've missed some. There really is a big variety. I've assisted our neurosurgeons when they do a bedside drainage of CSF from a VP shunt. You just never know. Of course, this is in addition to nursing procedures such as NG tube placement, foleys, PIV starts, blood draws, etc.

Is it more common for the patients to have central lines rather than peripheral iv's?

Yes, but it depends on the patient. Your sick patients that are requiring TPN, frequent/length antibiotic administration, vaso-active mediations, or high volumes of fluid/meds will have central lines. In general, we want to get the central lines out as soon as possible (infection risk) so when the child is more stable we will switch to a PIV.

Do you ever feel like you assignment is too heavy or do you find them fair and you can devote your time to good care?

This is really going to vary a lot depending on your facility. The nature of PICU is that it's constantly changing. You can start out with two relatively stable kids and before you know it both of them are going bad. Or your unit gets slammed with admissions and you suddenly find yourself managing two or three very sick patients. Or a child is coding and you need all hands on deck to help with that one child. On my unit, everyone is really great about helping each other out. If we have an emergency, like a code, and need lots of nurses in one room, one or two nurses (depending on how busy the unit is) will circulate, check on patients, do vitals, give medications that can't wait, etc. until the primary nurse can get back to their kids. While there have definitely been times that I've felt overwhelmed with work (it's usually paperwork more than patient-work) there is usually someone offering to help.

And ultimately can you say you love your job!?

Absolutely! PICU/NICU nursing is my passion and there isn't a day that I don't love taking care of my kids. Not to say that there aren't days that it isn't hard, stressful, and heart-wrenching. But I can honestly say there isn't any other field of nursing that I'd rather be doing.

shaykdo · Oct 15, 2012

Thank you for your responses! :)

HazelLPN, LPN · Oct 17, 2012

Its great that you have a background in hem/onc nursing as very few our our RNs could give IV chemo products. In fact, the only ones who could were former hem/onc nurses. You will be an excellent resource.

I retired three years ago after 54 years in nursing. I did med/surg, adult ICU, PICU and NICU and am still active as a volunteer assistant school nurse working with special needs high school students. PICU was my favorite place that I worked, hands down. If I would have had my career to do all over again, I would have been a PICU nurse from the start.

As far as procedures go, all of the above. If your PICU gets post op hearts, you also may have kiddos who's chests are still open and its not that uncommon for them to open them back up on the unit. If you take burns, then you have all that is involved with the burn care as well, although our burn nurses would always come down and help us with the dressing changes.

It was very painful for me to fully retire from PICU nursing. I had been semi retired for many years. Then my old broken down body just couldn't do it as well as it used to so I hung up my cap before people got a chance to say "she USED to be a good nurse, but now....."

If God gave me the body of a 40 year old again, I'd call up my nurse manager and get reoriented and start picking up contingent shifts again. Adult ICU and NICU were great, and I love the young people I work with now in school nursing, but I will always be a PICU nurse at heart.

Best wishes to you in your new career in Pediatric critical care...you'll do great!

Mrs. H.

shaykdo · Oct 24, 2012

Thank you very much for your input. Thats amazing you have 54 years in nursing you could write a book with all your stories! I have so much respect for you. I want PICU to be something I fall in love with, I want to dive head first in all of it. I start end of next month, a lot of the nurses on the adult oncology floor aren't understanding why I'm leaving.

Sloan RN · Oct 30, 2012

Most common bedside procedures on my unit: intubation, extubation, central line placement, arterial line placement, chest tube insertion, EVD placement. That's just a short list of the most common ones I can think of...there are obviously less common things like emergent opening of abdomens and such, and things that might happen more often depending on whether your PICU and PCICU is split and which side you work on (i.e. chest explorations are way more common in the PCICU) and whether or not you work in an ECMO facility (in which case you could be helping with ECMO cannulations and decannulations).

In my unit, only the sickest or most long-term patients have CVLs. There's a big push to pull them ASAP due to infection risk, so the typical patient just has PIVs. Cardiac patients are different: they all have central access all over the place, at least where I work.

The assignment question is completely facility specific. It helps to have a charge nurse that's out of staffing and an extra help-all nurse that's also out of staffing; if your facility has those, it'll make a big difference. That and having proactive charge nurses/management who are good about splitting pairs that become too busy.

I definitely love my job. There is nothing more rewarding...my husband is jealous that I get to do something so meaningful!