Hi everyone! I’m joining a PICU unit through my nurse residency program. I want to start off on the right foot in terms of knowledge and any advice you have for me. I would like to know what nursing topics you struggled with (I.e. ventilators, communication, meds,) and what you found most helpful to overcome the learning curve. Thank you so much everyone!

Has anyone transitioned from adult ICU to PICU? I’m wondering how different they are and how hard the transition would be.

I have been a nurse for 2 years (1.5 year in med/surg and 6 months in icu). I learned I like the ICU but I am getting burnt out from the adult world. My patients are heavy so I come home sore even though I’m 24. Also seems like many of the adults don’t listen to the advice we give them then they come back for the same reason (skipping dialysis or continue to smoke etc..)

Thank you for your input.

What are some good PICU/pediatric journals which accept case reports, any help is appreciated?

Any recommendations to give current graduating residents who will be starting ICU fellowship in the summer? I.E. books to read, articles, papers, videos..

I’ve been working in the NICU (level 3) for about 2 years and absolutely love it, but am finding it to be a bit repetitive. I advanced very quickly in my unit and love the highly acute patients and resuscitation nurse shifts. However I am still young and would like to challenge myself. I am concerned because I am very well aware that the PICU is completely different than the NICU and it would be like completely starting from square one. I was wondering if someone could give me a run down of what it is like working as a nurse in the PICU?

a free educational resource for pediatric surgery with a good library of mcqs, videos, charts

https://pediatricsurgery.club/

I’m a fairly new PICU nurse and I am in search of some guidance from seasoned PICU nurses willing to help me gain some confidence and improve my performance and skills. I was under the impression that I was doing well only to learn that how I perceive my performance is not the same as how others perceive it which was disheartening to say the least. It’s not a safety concern, it’s just not being at the clinical level that it’s believed I should be. What do I do going forward? How do I help myself to become a stronger PICU nurse?

Im newly hired at a small community hospital with very....strange practices. I wanted to ask if anyone has had similar experiences with similar management of a DKA pt.

The intensivist stopped checking gasses when the pH was 7.2 and not fully corrected. Additionally he allowed the pt to PO a full regular diet prior to being fully corrected and while still on the insulin drip.
My question is, has anyone else ever had an intensivist be this liberal with management? And if so, have the explained why they would stop checking gasses and allow a regular diet prior to correction?

What are your nurse to patient ratios for a new-admit, new-onset DKA?

Ex: blood glucose >1000, pH <6.5, bicarb undetectable; altered mental status —> potassium <1.8; Mg <1.5 despite 2-bag system and repletions.

Would you have other patients with this patient and, if so, how many?

Also, do you guys use intra aortic balloon pumps, pacemakers, CRRT, Swanz Ganz Catheters?? What type of modes of ventilation do you more commonly see? I’m a newer nurse in a different field trying to learn more about what you see in the PICU. Thanks!

Hello,

We are engineering students working on a senior design project about NG tubes for premature babies. We would greatly appreciate if you could fill out the survey below.

https://forms.gle/R97w9QcSwew356AZ6

Thank you so much for your time.

Hello! I am a current bioengineering student at Pitt and my and my team are looking for information into trach tubes in infants/ children and some common issues or complications people have encountered whether than be with insertion, management, or really anything. Any insight helps! Thanks again!

I have one year of nursing experience. I’m interested in switching to PICU and I have a few questions. -What are the pros/cons? -Does the schedule vary per child or are there care times? -What do 1:1 vs 1:2 assignments look like? -What types of things do you do/see on a day to day basis - drips, intubations, cooling, etc? -Are there different levels of PICUs? -Anything else you think I should know Thank you in advance!!!

I’ve been working in the NICU since I graduated May 2022. I worked as a tech and desk clerk there for all 4yrs of college. My mom has worked there for 36 years now and my sister also worked there from 2015-2018 (both as charge RNs). They used to have the highest retention of any unit in our hospital system. It was so competitive to even land a position in the unit.

Please try to refrain from negativity, nurses see/hear enough of it at work (and in the world in general). I know COVID has wrecked pretty much every unit in the hospital system but curious to read if anyone’s had success with rebuilding their unit.

One of my coworkers recently started a nurse wellness committee and ran a bake sale to raise funds to provide snacks a few times a month to staff. She also began doing a water drinking and steps challenge and placed all of us on teams. (In response to our annual staff satisfaction survey).

I love my job and want to strengthen it and make it a place where people want to show up despite the long hours and the insufficient pay and burnout etc. etc. etc.

I’ve been working in the nicu since I graduated in May 2022. I was speaking to an older traveler a few days ago who told me (politely) that our nicu in particular is really old school. She said she feels micromanaged here compared to some of the places she’s been. She mentioned Colorado Children’s has PRN X-rays (and I think PRN blood gases as well)… but they’re only able to do it because their providers give a ton of education to their nurses. In my unit, we of course rely heavily on our NPs and providers and do not have the liberty of ordering x-rays. I wouldn’t even know how to interpret the dang thing. :/

Was curious what sorts of RN education that would be? We have a S.T.A.B.L.E. course in my unit taught by our attendings and of course there’s RN-Certification but I’m just curious what other types of education are out there. I’m not going back to school and I know there’s online CE and conferences.

Should I just study a textbook? That can’t be all there is, right? There’s tons of stuff out there for adult critical care but the infant population has vastly different anatomy and physiology.

Any suggestions or experiences with any of the above?

Hi everyone, I'm a Ph.D. Student in Pediatric Psychology at Northeastern University and I am recruiting participants for a study that examines the barriers to visitations of primary caregivers (parents or legal guardians) during their children’s (ages 0-3) admission to a pediatric intensive care unit (PICU) or pediatric post-acute care hospital (pPACH)/Pediatric Rehabilitation. I am passing this information along in case there are individuals in your hospital, community, and network who may be interested in participating. If you would be willing to share information about the study with your organization and community, it could significantly contribute to the success of the research, and I would be deeply grateful!

To participate in the study:
- Primary caregivers must be at least 18 years of age.
- Primary caregivers must be able to read and respond to questions in English or Spanish. 
- The caregiver’s child must have been admitted to a pPACH or a PICU in the United States within the past 3 years.
- The caregiver’s child’s admission lasted, or has lasted, at least 28 days.

Participation in the study involves completing a 25-30-minute survey, available in English and in Spanish.

Please feel free to reach out with any questions or concerns. Thank you in advance for your time and consideration.

https://preview.redd.it/wdfbndbybwjb1.png?width=1545&format=png&auto=webp&s=afd84a25949358d8f30dced2e1a341e8e283d139

Childrens ecg conduction times: I have a hard time finding literature About childrens conduction times baby’s -> teenagers. Are the times in the link I added below correct? And does anyone have any literature about it? Thanks in advance.

https://dontforgetthebubbles.com/quick-reference/ecg-intervals-by-age/

Just curious if all units change their sterile fluid tubing/bags q24hrs despite the recommended practice of q48 (reduced risk of infection). If so, why?

I've only been an RN for 1 year so forgive me if the answer is obvious. Our unit does q24hr sterile fluid changes regardless of what the fluid is. The reason I'm asking is that I stumbled upon a NICU physicians' forum discussing this topic and figured I'd ask others ab this.

Working on a noise reduction bundle for my unit and thought I'd check with how other facilities tackle this difficult issue. Here's what I have so far;

Behavioral changes:

• staff education (ELearning module) on NICU noise bundle and the role each staff position plays in noise reduction
• elect “Sound Supervisors” from nursing at safety briefing ("unit huddle")
• “Shh.. I’m growing” signs requesting quiet voices and silenced cell-phones.

Environmental changes:

• ear protection be placed on all LBW infants,
• routine unit-wide “quiet hours” during both A-shift and P-shift
• sound-proof furniture with silicone bumpers on all metal bedside cart drawers and isolette doors,
• tuning alarm volumes to emit a max of 50dB. *Visual sound meters alone were noted to be unsuccessful in reducing sound.

I just finished my 1st year of medical school and will be starting an internship in the PICU soon. What are some of the most common diseases or protocols I should be familiar with prior to my start date? I was told I will be assigned 1-3 patients and expected to present and follow them each day. I would also like to know how to be a good rotating medical student in general. For example, what would be some helpful things I can do within my role?

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So far, I've come up with the following things to study:

-normal vitals for different age groups

-basics of ventilation and ECMO *my university has a big PCICU

-RSV, influenza, and COVID because I've heard we have a lot of that right now

-congenital cardiac diseases and/or genetic syndromes? I have no reference point for how common this would be in the PICU but I saw a lot of this while rounding with peds hospital medicine

Hello!! I am doing a project relating to common pediatric emergencies seen in ERs. I was wondering what are the most commonly seen issues/illnesses/injuries/etc are. If you work in the ER with children, it would benefit my research to answer in the google form linked. I do not record any personal data or share personal information, the form will not share it with me. https://docs.google.com/forms/d/e/1FAIpQLSc84pF9qPamDK9mKfVfY2uCMBDNSAIe4yzJEkBQjPIQJQpGPw/viewform?usp=sf_link

I'm building a new DKA protocol for my PICU.

What criteria (BOHB? AG? HCO3?) and thresholds do your institutions use when determining ability to transition from IV insulin to subcutaneous insulin?

Also, are any patients with mild or moderate DKA managed on the pediatric floor? If so, what are those criteria, and is IV vs SC insulin used?

Thanks in advance!

At our picu, we've noticed that neonates or young infants on inotropic support experience hypotensive episodes when the dialysate fluid is drained out during peritoneal dialysis cycles. I can't find any literature to support this. Have any of you noticed the same thing?

Hi. I'm a junior doctor quite new to PICUs and post cardiac surgery intensive care. In my unit, one of the main concerns following a TOF repair with transannular patch is "pulmonary over circulation".

Now, I understand that with procedures such as LMBT shunts, too much blood can flow through the shunt, thus "stealing" blood away from the systemic circulation and sending too much blood to the lungs. This increased flow through the pulmonary arteries can cause symptoms of "pulmonary overcirculation" such as pulmonary oedema and ventnilatory difficulties.

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However, following TOF repair, if I understand correctly, there should be 1:1 pulmonary to systemic circulation as the VSD which was responsible for the R-L shunt has been closed and the normal serial circulation of heart -> systemic -> heart -> lungs has been restored. (in other words, the entire systemic circulation must return to the right heart and then be pumped to the lungs). Why then, is pulmonary "over circulation" a concern following TOF repair with trans annular patch?

EDIT: This article seems to imply the Qp/Qs imbalance occurs due to residual VSDs. Is that the only cause of pulmonary over circulation? (or to put it another way, if the post op Echo shows no residual VSD, can I stop worrying about pulmonary overcirculation? )

Curious what resources/question banks people recommend for PCCM boards. Thanks!