PICU Training Flashcards
What are the shift routines for PICU?
Q1H vitals, validate iAware, I&Os, caregiver rounding
Q2H Full assessment, temperature, reposition, vent settings, restraints, chest tube
Q4H sat probe site change, oral care (and any other VAP bundle), CPAP/BIPAP skin check, PCA pump documentation
Q6H Girth with NG/NJ tubes and/or HFNC
Q12H Everything else i.e. wounds, diet type, alarms, braden score, humpty dumpty, handoff, IPOCS, education, ADLs, etc.
QThursday and Sundays clave changes and tubing changes
QThursdays central line dressing change
TPN/Lipids/Propofol change tubing Q24H
Change claves within 12H with propofol and blood products
How do you give bedside handoff?
By systems: Pt. name, weight, age, allergies, team, precautions Pt. hx and plan of care Neuro - include sedation and pain meds CV Resp GI/GU Skin Social Chart review Room check
What does the VAP bundle include?
Oral care Q4 hours - brush teeth 0800 and 2000, Green sage swabs w/ chlorhexidine 1200, 1600, 0000, 0400
Pt. without teeth pink swabs water, NS, or human milk: 0800 and 2000.
oral suction before turning and as needed
Elevate HOB at least 30 degrees
Evaluate sedation needs - possible sedation vacation?
Change suction canister weekly and suction tubing daily
RT perform assessment of vent Q6 hours
How do you transport a PICU patient?
Notify team you are leaving via Vocera “Broadcast to PICU transfer”. Ex. “bed 2310 is going to MRI”\
Notify CN, CCT, and RT
Take emergency equipment - bedside monitor, RSI kit, transport box
Have provider assess 30 min before transfer to floor
What are the CPP (cerebral perfusion pressure) guidelines by age?
< 2 months = CPP > 40 mmHg
2 mon - 1 year = CPP > 45 mmHg
1 yr - 12 yrs = CPP > 50 mmHg
> 12 years = CPP > 60 mmHg
What do you use to reach target CPP?
Use volume or pressors
Maintain CVP 5-8 using isotonic fluid; vasopressor support with norepi or epi
How do you calculate fluid maintenance?
< 10 kg = 100 ml/kg - daily requirement
10 - 20 = 1000 ml + 50ml/kg (for each kg above 10) - daily requirement
> 20 = 1500 ml + 20 ml/kg (for each kg above 20) - daily requirement
What fluids do you use for arterial lines?
NS with heparin
Explain the arterial line system set up
Set up and primed by CCTs
RN orders the art line fluids - > 10 kg = 3 ml/hr, < 10 kg = 1-3 ml/hr (must manually chart)
Change systems every Thursday and Sunday
Level with apex
Zero on initial placement, at beginning of shift with safety checks, with patient transfers, and if disconnected
When do you change art line tubing?
Sundays and Thursdays
How to do lab draw on art line?
Turn stop cock off to fluids - Pull back 2 ml (to black line) - quarter turn on syringe - clean access point with alcohol prep pad - use needle with blunt tip attached to draw up sample - flush line afterwards - turn stopcock back off to syringe
What is a normal CVP and what does low and high CVP indicate?
Normal = 4-8 mmHg
Low CVP - may indicate hypovolemia, vasodilation and increased contractility
High CVP - may indicate vasoconstriction, fluid overload, obstructive pulmonary disease
What makes a CVP line unique?
You can infuse medications through line and draw from line
Monitor line for blood backing up
where should you connect propofol?
connect to PIV or if central line then must change clave Q12
In children as the airway resistance ________ as airway radius _______
Airway resistance increases as airway radius decreases
What is the difference between ventilation and oxygenation?
Ventilation is the removal of CO2
Oxygenation is the delivery of oxygen “O’s to the toes”
What is diffusion?
passive process of gas exchange of carbon dioxide and oxygen at the alveolar-pulmonary capillaries.
How can we manipulate ventilation i.e. increase or decrease the removal of CO2?
Change the tidal volume which is the size of the breath
Change the respiratory rate - breathe faster to get rid of CO2
