Transporting pediatric patients with o2 after anesthesia

[kbarne01]

I am looking for evidence-base research for transporting a pediatric patient from PACU to the floor with O2 with O2 saturation monitor or without monitors. Is there an age in which you would not transport without a monitor. These are the pediatric patients that need O2 longer after anesthesia. I have worked in pediatrics for 30 years and have never thought about not transporting a pediatric patient without a monitor while on O2. But is some of the practice where I work that it is not done. I need evidence that this is best practice.

[GHGoonette, BSN, RN]

I don't know about any "evidence-based research" that I can quote you, but common sense should dictate that if the child is being transported with O2, the sats should be monitored. Even adults are usually monitored, and they don't desat as quickly as the kiddies. Doesn't make sense to me; after all, pretty well all the sats monitors out there function on battery, so why can't they just put it on the bed/trolley and maintain monitoring? What kind of distances are we looking at anyway?

[kbarne01]

Thank you, and I agree with you. Our current practice is: a tech (that has been trained in O2) transports patient with O2 unless there is an order for monitor. The age at which I am referring to is usually older children (over 12), but they have been given sedated/pain meds to where they can not keep there sats up without O2. A nurse has to transport patients that have orders to have monitors. This is fairly new Peds Pacu, the policy/procedures were written bases on the adult pacu policies, by adult nurses. The policy was written the way mostly because of limited RN staffing. It is the practice of the peds floors to place a peds patient on monitors if they have O2 unless otherwise ordered. This is children's hospital, but not a free standing. Having worked in pediatrics for 30 years, I too think it is "common sense", but the nursing world of evidence based to change policy I need proof. Now having said that after asking nurses in my unit about this policy, the history is most nurses that came from a pediatric background transported the patient themselves with a monitor. The ones that did not had adult backgrounds. I myself will ALWAYS transport patient with O2 on a monitor. Thank you so much for your response. I will keep pushing until I change practice.

[GHGoonette, BSN, RN]

Most of our paeds patients are post ent, urology or dental procedures, although we do have the occasional hernia repair or appendisectomy. I must say, it's never been necessary to transport kids with O2. We always make sure they are fully awake and have maintained a minimum of 94% saturation on room air before discharging them. We're not properly equipped to do larger paediatric surgery, so the issue of transporting with O2 never comes up. The last time I had to send a kiddie out with O2 was about ten or so years ago, a post tonsillectomy whose pharynx swelled badly post-op, and she had to stay overnight in ICU, incidentally at that time also not equipped for little ones. Due to her obstructive breathing, I had to take her down myself and we monitored sats all the way. You can't take risks with the kiddies; back in the Eighties one of our sister hospitals lost a lawsuit brought against them for a child left with brain damage (due to oxygen starvation) who had been discharged back to the ward without O2 and without continuous monitoring.

[RN1980]

if a pt is leaving pacu and is going to a floor room we dont take a monitor even if they are on o2. if the pt had telemetry on before the or or has it ordered for d/c from the pacu we will apply a unit before the pt rolls out the pacu. however, if the pt is leaving the pacu for the icu we have the monitors on when we roll with them. adults or kids.