1. Hi all,

    I am a new RN, working in an ER... Looking for people to share any tricks they use for treating/assessing pediatric patients in any area. I am hoping this will be a wonderful thread so that we can all share ideas to help us in treating our littlest patients.

    For example: Sometimes I find I have to put an IV in an AC on a kiddo, this is especially troublesome in infants and neonates since they prefer to be flexed. I use arm boards, but sometimes still find myself in an endless fight with a beeping IV pump and an arm that just wants to bend.... Anyone else doing something that works for such cases??

    Alright everyone, share your pediatric wisdom here!!

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    About AnnieOaklyRN, BSN, RN, EMT-P

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  3. by   RNmom08
    We use arm boards and occasionally have issues with the beeping. I'm afraid that goes with the territory for Peds. We have a way of taping that really really minimizes it though. THat's something that is very hard to put into words though. IT's much easier to show a person how to tape the IV whether it's to the hand, foot, scalp, etc. Let's just say... DO NOT BE AFRAID of tape! We had a child transfer to our smaller hospital from a well known one for the parents travel issues and we could not believe the inability of those people at the other facility to use tape. Mom said that they had to restart the IV 2X besides the initial start. NO WONDER! WHen we got the little one there was ONE piece of tape on it!

    I might add that we are also the lowest hopital wide for IV infections- probably due to the fact that organisms cannot find a way in! Also, our peds policy is different that the hospital wide policy that IV sites are changed every 72 hrs. We do not do that. We change the tubing Q72h but not the whole IV. Bags can only hang for 24h - seems like a lot of waste when some of our kids have only 30ml/hr running but that's the way it is.

    Other tips: Knowing what medication is ok to mix with juice is good to know. I do not put it in a bottle because I'm anal and don't want to risk them not taking the med. I will mix the med with a ratio of 1:3 med/juice mix and use a dropper so I can positively say they took their med. EX: 5ml of med in 15 mL of juice. Be careful of their NPO status though. Some docs will say Truly NPO while other say meds PO are ok but NPO on everything else If it's NPO status with only meds, I do not mix juice with it.

    Also for those on O2 NC, don't have the tubing running in the front of them. Put one piece of tape on each cheek, then with the tubing,go under the nose, over their ears, tape the tubing on top of the original tape (this prevents skin breakdown if you need a new peice of tape on the tubing, and then if you want tape an area in the back if you are worried about them strangling though that has not happened that I am aware of.
  4. by   AshM
    Where do you find which medications are ok to mix with juice? I have had multiple encounters with young ones not wanting to take their medicines.
  5. by   classicdame
    When I worked pedi our policy was not to have IV's in the antecubital space unless that was the only vein accessible. We even took them out if they were started in ER. We used EMLA cream for less painful starts. Most meds were IV to eliminate wrestling with PO meds. If a PO med was required, and was liquid, it goes into an oral syringe. The trick is how to hold their head with nose closed so that they HAVE to open their mouth. Usually ok with <2-3 years of age.

    Use a TB syringe for baby yankaur for suctioning. Red rubber urinary tube for nasal suctioning is flexible and small. Tongue depressors taped on palm helps keep hand IV's from being dislodged. Make a game out of blowing cotton balls across the over-the-bed table to get the patient to breathe deeper. I gave points for hitting the target (souffle cup). Then at end of shift gave a prize (time at the nurse's station, DVD of choice, time with the game box, ride in the wagon, milk shake (if allowed). Milk shades were made out of ice cream and milk. We kept blender on floor for this purpose.
  6. by   NicuGal
    If we held a child's nose closed to give Meds, we would be fired. And you should not be using with of those items to suction kids with, the make items specifically for peda use and your hospital should be buying them! Check out Neosuckers for nose auctioning.
  7. by   ShantheRN
    There's something to be said for good old fashioned bribery. If our Child Life department ever runs out of stickers, we could be in trouble!

    And holding noses shut to make kids take meds? Not too sure about that one....
  8. by   NicuGal phone did a great job auto correcting! Check out neosuckers for nose suctioning, they are nice and don't cause trauma. You shouldn't use non hospital approved items, if something goes wrong, you are held liable.
  9. by   anon456
    I agree about using proper equipment. I have the hardest time with giving meds to the three year olds. Sticker charts and toys are a good thing. for babies and toddlers we squirt the med into their cheeks a little at a time. Never hold the nose! The hardest kids I had were two different Kawasaki patients who had to take childrens asprin every few hours. We tried crushing it and hiding it in pudding and such but the kids get wise to it, esp at 3 AM when you expect them to wake up and take it. Sometimes a kid just wont take meds and that's that. They get an NG or IV meds. We get kids who have T&A and go home and refuse to drink or take meds. They come back in for a day or two more of IV therapy.I agree to use tape liberally for IVs and monitoring equipment but make sure you can assess the IV site under all that tape and armboards on a regular basis. If the kids won't leave their lines alone, esp PICCS and oxygen and trachs and things, and parents are not there we will get sitters for them.
  10. by   misscherie
    Distraction is key!

    Blowing up a glove and tying it then drawing eyes above the thumb (which is now the nose) or blowing bubbles (can help with children who need to breathe deeper).

    I find that if the child has 'stranger danger' (at certain developmental ages), talk to the parents first then they will warm to you rather than directly going to the child. If the child is friendly and relaxed then definitely talk to the child as that is who your patient is.

    I think patience and honesty goes a long way with kids! If you say it's not going to hurt (and it does), good luck trying to gain their trust to get you to do anything ever again!
  11. by   gahills
    one trick for giving meds is wait till they are asleep(if able to wait). works well for 2 and under. Just slip the tip of the po syringe in their mouth and their sucking reflex kicks in and they take their medicine pretty well. If they wake up its usually after they have swallowed. I used this on my old son alot. If they take a paci when they sleep its even easier. Also dont give younger children po tylenol for high fever (especially if they have Pylonephritis) because they always vomit go ahead and give it PR.