AMR21

If I have time and access I like to give an amp over 10 min.

I have a question about blood cultures. I'm a PICU nurse. We have pts w dialysis lines a lot. Temporary, permanent, subclavian, femoral. Seen nearly them all. We are good at hep locks/ citrate locks/ even been seeing some TPA locked lines. We are well versed in Bc we run out own CRRT. How about the kid on hemodialysis every other day who spikes a fever and is not due for dialysis yet. I want peripheral, CVL/PICC, Aline cultures before starting new antibiotics. Should I break into the HD line and re lock it? We don't have a protocol yet and I'm interested to see what others do.

We empty into the hopper in the dirty utility. New bag every time.

We recently had to present a diploma to be able to run out ISTAT machines. They didn't even care what diploma it was. I couldn't find my one from nursing school so I brought in my one from my BA in anthropology. Honestly, I have zero idea why. The medics in the ED at the same facility can run ISTATS. Most of them have yet to attend college. Dumb.

Peds ICU nurse is slightly freaking out about that question. There has been no research about what about of air could be harmful to a Peds pt. in a "heathy" kid it might be ok. In a kid w a PFO, deadly. Air emboi are no joke. I've taken care of a gentleman who received one to the brain. Devastated. The other night my ECMO circuit nearly shut down bc of a tiny amount of air from a flush in a cvl.

We dual sign off all infusions at shift change. A couple nurses read drips as "migs per kig per hour" I don't know why it gets to me. Please, "milligrams per kilogram per hour"

A woman I work w stages hers in a little plastic school box. Like a pencil box from elementary school. Seems to work.

Not where I work. If you have 'a disease of childhood' or have been refinery followed by one of the doc at our childrens hospital u end up in PICU. I really have had a 60 year old pt. it's fun looking at the central monitors and wondering if that HR of 50 is a baby or an adult ... Nursing in General is hardcore. I think you can be 'intense' wherever you want.

Try PICU nursing. Every speciality rolled into one. Ages 1 day- 60+ years. Ecmo, crrt, codes, multiple sizes I've every every single device. Kiddos can be fine one second and just crump the next. Every single day we are seeing new things. On top of that put the pressure of families. No one wants to say it out loud, but loosing a kid is not an option. So we do everything. In every case. And it can be beyond rough.

In re: mistakes. We ALL make them. Best thing you can do is learn why is was a mistake, why it happened, and how you will never let it happen again. Keep your chin up. Nursing is hard. I bet teaches don't fill the guilt like we do when they grade a paper wrong, or bankers when they mess up a decimal point. Our mistakes can really harm others and we are all too aware of that. Being vigilant and methodical and always open to feedback will help you tons and you continue to learn. In re: the central line. I work in a busy Picu. We never disconnect and reconnect central lines. Leave the unvalved part of your extension port open for lab draws and such. If something has to be disconnected, we start over w new tubing, caps etc. (Yeah, don't disconnect that TPN/IL.) following this principal has helped a LOT!

I think it's called The London Hospital. On amazon prime. About nurses at The London in the 1800s. Loved it!

I must work at Fort Knox. Everything but saline flushes and sterile water for reconstituting meds like vec is in the Pyxis or comes from pharmacy. And to override anything we need 2 RNs. And once something is an override it pops up as a big purple line or the eMAR until it is linked to an order. Guess that's why I'm so used to needing an order for EVERYTHING.

Without the NS order how are you pulling the 50 ml bag from the Pyxis? How are you charging the pt for said bag? Perhaps where I work is just strict and MDs are understanding. But I would get an order.

Hope it pans out. I would love a place to find picu specific articles and such in one place!

Where I work, the social worker had like emergency ballots or something. Contact them.

Really?! I have a latex allergy. Never had any problems. Where are you looking!

I have used them in peds. They really only work for people who have nothing much attached to them. Dealing w iv tubing, feed tubing, monitor cables is a big hassle for staff and I almost need a sitter in the room anyway to keep them tangle free. For people who are all over the bed and a free from cables, etc they are great.

Are there any picu specific nursing journals out there? If not, what nursing journals does everyone subscribe to? How about conferences?

When I left, I wrote the standard resignation letter but added in that I was willing and interested to stay PRN. Two days later, I stopped into my managers office and she had me sign a PRN agreement. I ended up coming back full time to that until after only 16 months of working elsewhere. My advice is stay on good terms w management.

Hopefully your facility has a good pharmacist. The can be your best friend when it comes to compability questions when you either can't find an answer or get conflicting answers. I always chart something like Per Bob, pharmD, OK to run x and x together. At my hospital they are always willing to help you figure anything out!!!

We have been on full computer charting for a long time. Since before I began. Perhaps the Unit Coordinator's role has evolved in that time, but out PICU couldn't run without one. They do all our welcome info packets, door signs, check to ensure the correct isolation signs are up, answer the endlessly ringing phone, are able to take some critical lab results that are called, order special items/beds from central supply, get callers to give care code before transferring to RN (I always verify a second time). They also distribute and sort daily goal sheets, print charge report sheets, keep up on the 'travel' sign in/out book, screen visitors as our unit is locked and has strict visitation rules, update the hard copy book of all admits/ transfers/ expirations. In addition, the have the ability to page speciality services, parents, or security quicker then lightening in emergencies. I love love love our UCs. We have 2 on the unit 24/7 and they keep busy.

Alphabet soup For the kid w so many diagnoses you can't possibly list them all (mr, cp, g/j tube, vp shunt, asd, vsd, ...)

I work in a PIcU. We replace for k less then 3. When I did a short stent in the adult world we replaced for less then 4.

Lydia's unifies is great too. Carry urbane in the linger length which I love. Sign up for their texts for coupons.

Thanks for all the input!