tips for pediatric OR?

ChristineAdrianaRN, BSN, RN · Aug 10, 2011

Hey there, I just started in a peds OR a few weeks ago, so I don't really have a lot of advice quite yet.

The only things I can offer:

- I thought working on a post-op floor in adults might be helpful, but the

peds saying, "Kids are not little adults" has never rung more true. A lot of the cases are peds specific, especially some of genetic defect stuff, so I'm seeing a lot of new stuff.

- Knowing the kid's weight is supremely important. Anesthesia needs to know it for dosing, and you need to know it because age does not dictate size. You get some really developmentally delayed grade-school kids that look like toddlers and the other day I saw a 95 lb 3 year old. Then there's the teenagers that are 300+ lbs. That changes how you set things up, like the safety straps/arm boards, bovie pad size, etc.

- Knowing what flavor anesthesia mask they want is important! :)

- Distraction is key. We play a movie over the OR table ane generally keep them interested in conversation (while still explaining what we are doing) because a lot of these kids can be pretty scared. Luckily our hospital has a Child Life Specialist who does a lot of preparation with the kids for surgery, so most of the time they are actually not too freaked out to be there because they've already been prepped on what's going to go on. Other times the specialist will come into the OR with the kid, which is also really helpful for the difficult ones.

- For toddlers, a blood pressure cuff is a "muscle tester", a pulse ox is a "glow in the dark sticker", an oxygen mask is, "We're just going to give you a little fresh air"...etc etc. You will learn how to talk to them.

- Don't be freaked out if anesthesia basically has to hold a screaming kid down while they hold the mask to their face. At first this freaked me out as it seemed pretty barbaric, but sometimes there is no other way, and they're out in like a minute anyway. Just be prepared for it.

That's all I got. Like you, I have never worked with peds before this, either. But I LOOOVE it! Good luck!

linguine · Aug 13, 2011

Thank you for those insights. Flavored anesthesia masks? Never knew they had these.

NurseSnarky · Aug 13, 2011

A lot of places put flavored lip balm on the masks...so there are options for kids if there are multiple flavors. Otherwise you don't give options or ask "is that okay...do you want to do that...do you want to say bye to mommy now and go with me..." NONE of that. Find out what they like and what sports they like or what books they read ect...and start using the distraction technique. Sometimes you will go "we're going now" and the screaming starts. If they are not too big, you wrap them up in a warm blanket and pick them up and walk fast! I always ask (even the screamers) to push the button to open the door with their foot and praise, praise, praise. LOTS of praise. We mummy wrap all of our kids...so you already have them wrapped then lay them down and then wrap again...get the pulse ox on asap and you just hold them down gently...no squishing of course. I will many times rock and shush/comfort on the way back and come into the room, introduce them to everyone in the room...lay them down with my head near their ear if not in anesthesia's way and just go shhhhhh...it's okay. Blow that air out FAST! Some CRNAs like to ask them to "blow up the balloon", but that's if the child is not super upset...the ones that cooperate.

Even when mummy wrapped, they will kick a lot and that's why you have to lay over them and again just comfort as much as you can. I had a super screamer Monday...he was so good about the open the door with his foot part though. :) I was really worried he'd come up in PACU a wild child. I comforted and shhhhh'd in his ear until he was asleep. Girls said he woke up great. :up:

Also our anesthesia will let us put in IVs on the little ones...helps to keep up your skills. So jump right in and don't be a wall flower on that. Best way I learned was bending the hand down (looks like 90 degree angle if you can picture that, with your hand in thier's. Their hand coming over the top of yours...you're holding it and their fingers are in your palm) and get a hand vein. I don't have as much success with a laying flat hand as I do with that method. Always have IV set available and primed in the room. And I always try to follow up in discharge with the kids even when they are still pretty upset from waking. I praise them and give them thumbs up, etc.

Oh in longer cases or with nervous parents...I always keep them up to date on how their child is doing. Not everyone...but I had a VERY tearful, scared mother a few weeks ago and she calmed down when I touched her shoulder and told her I would make sure she was kept abreast of things. I then went and talked to her several times and she was calm throughout.

ChristineAdrianaRN, BSN, RN · Aug 18, 2011

Good point on the "asking if they want to do something" thing. If you say, "Do you want to come over to the table now?" they will say no, and then what? But trying to give them choices - "Do you want to sit up or lay down?" while still getting them to do what they need to do is ideal.

Yes, they do have flavors in the anesthesia masks. A lot of times that's what the kids are so excited about, so I talk it up on the way in, and then they are excited for it and more cooperative (usually). :)