PICU patient returning or going straight to PICU versus PACU

[debberslnc]

What are the advantages for extubated patients going straight to PICU versus stopping off in PACU?

[NicuGal, MSN, RN]

It is easier to get them back up and settled right away than to wait for them since they are usually already assigned as a 1:1 or 1:2. All of our ICUs, adult or peds, recover their own patients.

I know our PACU would rather them come back to us in case we need to manage their airways, fluids, etc.

[TheCommuter, BSN, RN]

Moved to the PICU forum for more feedback.

[chare]

I'm not sure exactly what you're asking, or why. However, as a PICU RN, if the PICU bed is available, I would reverse the question and ask: What are the advantages for extubated patients stopping off in PACU versus going straight to PICU?

[Rose_Queen, BSN, MSN, RN]

My facility doesn't have a PICU, but the only patients who bypass PACU are those who are intubated. Regardless of level of care, a patient who is extubated goes to PACU.

[brownbook]

In my humble opinion if a pediatric patient is sick enough to need to be in the PICU, even if they are extubated, they should go there after sedation/surgery. The PICU staff knows peds, peds dosages, peds care, etc.

PACU nurses are very competent and can and do recover peds patients, but they do not deal daily with peds and there is a greater possibility for mistakes to happen. (Those pesky teeny tiny meds dosages). Or just not to have certain supplies right at hand from diapers to restraints, face mask, blood pressure cuff, etc. (Ideally they were given a heads up and have the supplies ready, but stuff happens.)

I would assume the patient is a 1 : 1 in the PICU for several hours?

I am curious why you ask, do you work PACU or PICU?

[NotReady4PrimeTime, RN]

Right off the top of my head - not stopping in PACU eliminates one hand-off, and therefore decreases risk of errors and omissions. Having said that, I often get a much more complete report from the PACU nurse than I do from the anaesthetist. If I've sent the kid to the OR for a procedure, I expect to receive him back from the OR and not PACU. What frosts my cookies is when we get a kid from the OR because the anaesthetist doesn't want to hang around to make sure the kid's good for the floor and sends an awake, extubated, stable-but-hangry kid to us so s/he can go home.

Brownbook, your comment about PACU nurses not being comfortable with recovering peds patients suggests you're in a hosital without a PICU. If the hospital handles enough pediatric patients to have a PICU, they're also going to have pediatric surgeons, pediatric anaesthetists and pediatric recovery nurses. I work in a "hospital-within-a-hospital" setting, where we have sections of each floor carved out as pediatric spaces. Our staff do not overlap. The children's hospital staff do not interchange with the adult hospital staff, except when it comes to burns patients. Oh, and one of our cardiac surgeons does the occasional surgery on adults, but those patients are operated on in the adult theatre with adult OR staff, then they're recovered either in the adult PACU or the adult CVICU - never the twain shall meet.

[offlabel]

Ordinarily, an extubated adult that is headed for the ICU is better off going to the PACU because that's where anesthesia is. Emergencies and returns to the OR are a lot easier handled when anesthesia folks are standing around or immediately available (a lot of the time, anyway).

Peds are a little different in that experienced peds ICU nurses are more dialed in to peds and their problems. That isn't a slight, it just is what it is. A peds intensivist is usually hanging around up there too, and it isn't as if the anesthetist is leaving before the child is stable and safe, so it makes more sense to me that a kid heading to the ICU anyway go there intubated or not.

That said, if it's a peds specific PACU, then same rules apply as for adults. Helps move the OR schedule along as well.

[minim, BSN, RN]

As a PICU nurse, I've noticed that PICU nurses get frustrated if the PACU is by-passed for "simplicity" or what-have-you. The PICU protocols for recovering a pt are extensive, vitals q 5 min, then 15, then 30, which can be time-consuming and take away from our other's pt's care. If you have a peds PACU, send them there. If you don't have a peds PACU, its another story, as PICU nurses are quite protective of their babies... but we appreciate all the PACU does and like them to be utilized.

[guest940422]

It is facility specific

Freestanding Children's Hospital: All PICU patients should be recovered in PICU, it eliminates a handoff and prevents the patient from loosing their bed while they are in PACU. The PACU RN and PICU RN have all the same resources and ratios so there is no reason to tie up a PACU bed for a patient that is just passing through to someone who can do the same thing. Plus the anesthesiologist goes with the patient from surgery PACU transport to PICU will not have the same luxury

All floor patients should go to PACU and be fully recovered prior to being sent to the floor. The PACU nurses are pedi PACU nurses and experts on recovering pedi patients. in a freestanding children's hospital a patient going to an acute care floor should not be recovered in PICU unless the PACU is full and that really shouldn't happen. Recovering a floor patient in PICU waists resources, they have critical patients and have to recover a patient and do all the admission documentation since they are being admitted to the PICU, just to transfer them to the floor a few hours later

Adult hospital with pediatric unit and/or picu

EVERY pedi patient should be recovered in PICU unless they just happen to have a rocking pedi surgical program and they have pedi specific pacu (I've never seen this)

kids wake up from anasthesia different from adults, they have different and less stable airways, and in general most adult nurses would rather run naked through downtown than even witness a pedi code never mind assisting in one. they aren't use to weight based dosing and the picu is just a safer place for the patient to recover. Generous hospitals will have a short form for recovery patients so the picu nurse doesn't have to document a full admission on a patient they are just going to recover and send to acute care in 2 hours, alas most dont, it can be a drain but it is much safer for the kiddo