suzy192

i work in a combines cardiac/picu unit and i must say that the cardiacs can be the most challenging of all the patients. They are the ones everyone gets most nervous about. Being quite specialised you have a whole range of things you have to monitor and think about that you wouldnt even think of in the general picu kids. CVICU will build up you skills amazingly, i say go for it.

my unit uses leucoplast, its very secure and sticks well to the skin. Only prob is when you have snotty kids, the tape doesnt stick well with excess moisture but then what tape does. The snotty kids just get more frequent retapes. We dont have very many accidental extubations using this tape and we are always quick to retape our tubes post theatre as they use silly tape which we just dont trust.

In my unit we have a protocol to double pump if the child is unstable or on multiple inotropes. If its dopamine or dobutamine its can be just a quick change out but i like to double pump, then i get less issues. I have my new syringe set up and running but not attached for an hour prior to the change to build up pressure in the line, then attach it and clamp off the old line (i leave it connected for a while in case there are issues). I like to have someone with me at the bedside just incase, or i let the other nurses in the room know. If it was a really unstable kid i might have both infusions connected and running together (new and old) and gradually titrate rates until the old syringe is off and the new is at the full rate (ie start new syringe at 10% of rate and reduce old syringe to 90% so that patient is still getting the same dose, then titrate as tolerated). With sick kids i would let the medical staff know what i was doing so they know to come asap if needed. You get the odd accidental purge/lag now and then. I like the idea of having spare adrenaline drawn up for just incase, u can never be too careful. Most of the people in my PICU follow these techniques and we dont often have issues.