melbae9

I was not under the impression RNs were not allowed to push propofol or sux. For intubation we use fentanyl since it has the least risks from a cardiac standpoint in regards to hypotension or bradycardia and always a paralytic, sometimes Cis but usually Roc.

We definitely try to get our VAD kiddos to our step-down unit ASAP. We have VAD engineers who manage the pump and are responsible for checking it and our step-down unit as pretty awesome nurse patient ratios. Whenever possible VADs are in a 2:1 assignment or 3:1 at the most. It tends to get a little tricky when there are multiple VADs though. Kids really do much better in the step-down unit once they're allowed to be kids again.. They're allowed to go to playrooms, walk outside, etc. As far as dressing changes go, they get sedation in the beginning while their sites are healing, but eventually they don't seem to need anything. Childlife is really good at providing distraction tools or getting music therapy involved.

I work in a Pediatric CICU. We use heparin and lovenox together routinely. Lovenox can take several doses to reach therapeutic levels. Therefore, when someone has a known clot, giving heparin until the lovenox kicks in keeps the patient anti-coagulated. I've even sent kids home on coumadin and lovenox together. Sometimes the benefits simply outweigh the risks. It certainly wouldn't hurt to clarify though and make sure D/C'ing the heparin wasn't an oversight.