PICU Nurses

[biscuit_007]

Any PICU nurses out here? Where do you work? How is your staffing? How many RN openings are on your unit? How do you like where you work?

Let's try to get a dialogue going about PICU issues!:roll

[pedseducator]

I forgot to mention that the heparin flushed are for central venous lines:)

Thanks,

Pedseducator

[NotReady4PrimeTime, RN]

I have worked PICU for many years and love it. I need some help with concentrations of heparin flushes for either age-wise or weight-based dosing. If anyone can help, it would be greatly appreciated. Need to know what the rest of the world is doing.

PICU nurses have huge hearts!

Pedseducator

We use commercially available premixed heparin lock solution for most of our patients. It's the 10 units/ mL solution and if it's used properly, we don't have any problems with it. For neonates, we use preservative-free heparin lock solution prepared by our pharmacy. It too is 10 units/ mL and comes in pre-filled syringes. The volume of the flush depends on the volume of the lumen. UVCs only need 1 mL, most short term lines only need 2 mL and the tunneled ones the volume on the port plus 1 mL.

Now, our pressure lines are a horse of a different color. We use a 1:1 solution for all lines on kids over 10 kg on a pressure bag at 3 mL an hour and 2:1 solution for the little ones, on a pump at 1.5 mL an hour for art lines and 1 mL an hour for CVP, LAP, and RAP lines. We almost never have PA lines.

[bungee]

Hello all...

I started out my PICU career in 2001 at Childrens Hospital of Oakland. I loved it there and miss many of my old friends.

After not being able to afford a good home in the bay area, my wife and I decided to move north the the great pacific west. What did we find? RAIN RAIN RAIN.

I am currently employed at a Portland based childrens hospital and have been here for the past 4 years. The people here are incredible also. My only gripe is that we do not have 24 hour in-house coverage. Working 7p-7a can put a lot of stress on RN's with no doc in house.

No place like the PICU!!

[PEDSVA]

Great dialogs. I no longer work in the PICU (miss it )but it's been fun reading these posts. Keep it going

[googabin02]

I work at a PICU in pennsylvania. I typically have two kids, if they are both "stable." We have great teamwork here and are planning on building a new childrens hospital so that should be nice. Right now we are a twelve bed unit, and we need about 20-25! Welcome

[nursenpnk, RN]

I have been in the PICU in connecticut for the past 6 months, I transitioned from the adult world to the pediatric world and still do both, but LOVE my kidders much more than my adults. We are an 18 bed unit that takes med/surg, cardiac,neuro,and trauma so a lil bit of everything. We have some 36hr nurses and some 40 with the option of picking up extra as we still have a few positions to be filled. We have A LOT of new nurses, there are times when the most experienced nurse, besides the resource nurses, only has 2-3 years of experience. However, we are really growing and making great strides in pt care. Our pt care ratios are usually 2 pts to one nurse, unless we have a sick cardiac or very serious kiddo then they are 1:1, occasionally we will triple our lil ones that are heading out to the floor or are chronic vents that need vent checks and daily care.

[Mimsy909]

Hi all, happy to find this site. I've been an RN for 28 years, always pedi, and a PICU nurse for 24. I couln't imagine doing anything else, though I've tried! My unit is 16 beds, is multidisciplinary and affilitated with Brown Univ. medical school. We don't see cardiacs other than for stabilization and transport to Boston. We do have a very active transport team and care for some extremely ill children. Due to the general nursing shortage, our institution has initiated a critical care intern program where new grads can make the leap into the ICUs without prior experience. We offer them an extended orientation, an identified resource nurse when newly off orientation but.......then what? Several of my "older" colleagues and I want to offer some sort of support group to help them after they lose their first patient, encounter their first code, have the day from he** that we've all had (but know how to deal with). Is there anyone out there who has similar experience or wishes they had that or has a suggestion of how/what we could do for our new little chickens. Thanks. Keep up the good work. Mimsy

[NotReady4PrimeTime, RN]

We've actually just agreed to implement a peer support group of experienced "old-timers" who will be available at anytime for new and not-so-new staff to take their issues to. We've slid into a really dysfunctional state and are now identifying and beginning to address the underlying causes. This was something that both management and bedside staff agreed was a significant problem. One of our staff nurses has taken on the development of our group. The goal is to provide support in any type of situation and to act as a sounding board/hand-holder for issues that may need to be taken further. There will be a letter written to be included in tthe orientation package all our new hires get, introducing the team and providing contact information. There will also be a list posted in the union binder in our staff room. All interactions will be held in confidence unless to do so would be against the law, the nursing professionals' act or would endanger someone else. I've already been acting in this capacity for several years in an informal way.

Unfortunately our unit doesn't provide the same level of education and nurturing of new nurses as yours does, Mimsy. That's something we've also agreed to address. Our nurse-educator is brand-new to the role in our unit and has good insight into how to change our orientation so that new nurses are better prepared and supported. We'll see how it goes, but I'm hopeful that we'll be able to improve the conditions in our unit at least a little.

[rayne31]

:redpinkhe This is my first post. I have worked in pediatrics for 6 years and PICU for almost 2 years. I live and work in South Texas. I have recently changed jobs and will be working in a fast paced high acuity PICU. I am really looking for websites to brush up on my knowledge. I would like to put together an education notebook of information for PICU nurses to reference.

[NotReady4PrimeTime, RN]

Give me a few minutes, I have a bunch of good resources for you, but I'm kinda multi-tasking right now and will need a little while to sort it all out so I can devote my full attention to this!

[PEDSVA]

Rayne31,

When you get your resource book together could you post it on this thread or PM me a copy ,if possible. I am thinking of finally returning to PICU within the year and would love to brush up on some things over the next "9 months". Good luck with your endeavor.

[NotReady4PrimeTime, RN]

Okay, here are some of the resources I've found helpful in the past:

Pain Assessment: http://www.medscape.com/viewarticle/452694?mpid=13281

Cardiovascular Care: http://www.cincinnatichildrens.org/health/heart-encyclopedia/

Cardiovascular Pharmacology: http://www.medscape.com/viewarticle/452691?mpid=13759&WebLogicSession=Pswqr2Tn0hKPWtpVnAJT0Ef15gBhojklVtAly1mTXgFjOBKseUWG|7728315570410925416/184161393/6/7001/7001/7002/7002/7001/-1

RSV and other LRTIs: http://www.medscape.com/viewarticle/452573?mpid=13481

Genetic disorders: http://www.ncbi.nlm.nih.gov/sites/entrez?db=omim

Orthopedics: http://pediatric-orthopedics.com/Topics/topics.html

Pediatric Critical Care: http://pedsccm.org/ (This one is hugely helpful on many topics)

I also have a copy of the AACN's Core Curriculum for Pediactric Critical Care Nursing. It's an amazingly comprehensive reference; I like it so much that when the second edition came out, I bought it even though there aren't huge changes from the first edition.