Rsv

Mattigan, RN · Mar 13, 2003

Originally posted by nurs4kids
I'm a bit confused by the isolation suggestions here..

we only use contact isolation with rsv pts..not droplet, no mask necessary

good handwashing is the greatest defense.

My latest newsletter from American Academy of Pediatrics still says Respiratory/Contact and the Infection Control nurse here agrees but I agree with you.

Our problem is we have physicians who still use Ribavirin therapy on kids who aren't on vents. It's on a general pedi floor and I have concerns with that.

Reabock · Mar 14, 2003

We get kids with RSV every winter thru spring, sometimes starts as early as Sept. and is still going strong at present time. Peds nurses have to cope with kids in isol, contact and droplet, and taking care of adult pts at the same time, same floor, usually next door to each other, some nights it seems like all I do is gown, mask, wash gown., mask, wash all night. Hate the static in the Isolation gowns, but I seem to attract static. :confused:

Seems like most of the parents or grandparents( that i have observed) of RSV kids smoke, we give literature on the smoking-sick kid connection and the little non-smoking talk but very few ever do anything about it and seem to be outside frequently on a smoke break, parents, etc don't wear isol garb but cannot go in others rooms but seem to be in the hall a lot so don't know how effective Isolation is with those condtions. Parents stay with their kids most of the time or arrange to have a friend or grandparent stay if they can't. Most are on cardio-resp monitor or space lab if under a year or if MD orders it, sometimes we do it anyway. We don't use tents as much as we did and, yes, we do a lot of CPT or beating on the kids as the Docs call it. Have to tell parents they can pound alittle harder with a cupped hand than a gentle pat, the kid won't break. CPT dept does all breathing RXs and CPT except if we see they need CPT when we are in the room. I guess this is long enough, guess I am more tired than I thought, up at 0730 to hosp to be with my dad with a bad GI bleed, 2 gatros in 1 day and an emergency transfer to a bigger hospital 1 1/2 hours away over nasty snowy, sleety roads. Its a lot different being the family member, not the nurse!!

Sharon · Mar 19, 2003

RSV type infections are trickier then what the hospitals would like you to believe. The last outbreak I worked I had 10 admissions under 14 days old in 12 hours. I had to stimulate the breathing in four until the 12 hour when beds open in a PICU. The outbreak was so wide spread that all infants, peds and caregivers contracted the infection. Some of the adults developed ARDS. Approximately a month or two later there was a sharp increase of community acquired pneumonia in teens, young adults, and adults. We ended up with three hospital healthcare providers ventilated for the pneumonia, (a nurse, a pharmacist and a physician). None of the ventilated hospital staff/patients where pediatric staff. All pediactirc providers took it home to other family members.

Pediatric RSV sequelae have been researched more often than adult. Recently my PCP who is IM and OEH has stated there are new proposed hypotheses that RSV illness in adults will trigger various autoimmune illnesses such as asthma, IDDm, etc..

The infection coming out of South East Asia is suspected to be from the same family as RSV the paramyxovirus.

NicuGal, MSN, RN · Apr 2, 2003

For RSV our peds floors gown and mask. All our little ones that qualify for Synergis get the first dose before d/c and every month until the end of April. We start dosing in October. We have seen a dramatic drop in RSV admissions of our previous preemies. Also, we have never been turned down from medicaid or private insurance for Synergis.

NicuNsg · Jun 1, 2003

I have kiddos that get Synergis and all have remained complication free during the season.... My son was a Respigam kid, this is an immunoglobulin given each month beginning in Oct. and ending in Feb., he was a BPD'r and did in fact get RSV, happy to say he was 2 days in the hospital on the peds floor (no vent, no tent!!) on 02 via nasal cannula. That works fabulous for preemies and chronic lungers.

eb_rn · Jun 5, 2003

most of our RSV'rs get o2 via nasal canula, a bronchiolitis pathway via RT--flovent/atrovent, etc--and LOTS, did i mention LOTS of suctioning!!!!!!!!!!!!!!!!!!!!!! we usually only use gown and gloves and we have pedi size yonkers which really helps, but we use catheters for deep suction......this usually wierds-out the parents, but once they realize that we r "blowing their noses for them" they r ok with it. if they have increased WOB, and cant tolerate po feeds, they get a ng tube, unless they have a hx of reflux then we might use TPT-transpyloric tubes for feeds...and most start with ivfluids for hydration, we dont usually use a mist tent. Pulse ox is a must.....and did i mention suctioning!!! lots and lots of suctioning. it can be a scarey experience for parents..especially of preemies and BPDrs...we also use synergist--er how ever we spell it--especially with our chronic vent kids...it seems to help, i dont recall on "outbreak" of RSV in the vent room last season...speaking to seasons of RSV we did have a case in July last year...that is unusual for us.

eb_rn · Jun 5, 2003

and to add, good handwashing is the best defense to almost anything! especially with RSV.

IRISHBREAD · Jun 12, 2003

i took care of a baby with rsv this month. it still hasn't ended. and i did a culture today for it in a 15 mo old today. doesn't the virus know the season is ended!!!!!!!

fat420cats · Jun 15, 2003

it's contact precautions with rsv. good hand washing. rsv is a fancy name for colds. babies get very sick with it because their lungs are not mature enough to handle it.

Pediatric Critical Care Columnist · Jul 4, 2003

A couple of years ago, we had a stream of prems coming in with RSV only days after discharge from the special care nursery. (Say whut?) One little kiddy was so sick she failed conventional ventilation, failed HFOV and ended up needing HFJV. She developed NEC, had a bowel resection and ileostomy plus had a honking huge pressure ore on the side of her head from being in one position for weeks.

Then last year, there was an outbreak of RSV in the NICU!!!! We PICU nurses (who they always made to feel unworthy and unclean) gloated a bit on that one, since we had ZERO nosocomial RSV that year. Of course, we had to take all their RSV patients... seemed like we emptied out their unit!

HFOV= high frequency oscillation ventilation (rates of 300+/min with miniscule tidal volumes... keeps the lungs fully expanded... similar to a panting dog)

HFJV= high frequency jet ventilation (small tidal volumes delivered at high velocity creating laminar air flow with O2 in the middle and CO2 at the outside, penetrates to the terminal airways... for more info... http://www.bunl.com/howhfjv.html )