Emla and freeze spray can be used. Emla should be applied ~30 minutes prior to procedure.
2.
1. Sterile environment, caregivers can be present.
Nurse has to touch the port area to find the access point. 3. Clean site of port. Port will be accessed with a needle. 4.
** There can be a single access or a double access, double access requires two separate needles. a.
Emla & Freeze Spray
5.
Very helpful for the patient to take deep breaths and focus on breathing.
6.
Ask if they would like any distraction such as watching something on YouTube, accessing the port is uncomfortable.
7.
Once the port is accessed, dressing goes on top.
Nurse hooks up machine and patient will begin receiving chemotherapy. 8. DRESSING CHANGE
Duration: 10-15 minutes
Most painful part is removing the dressing. Adhesive removal is very helpful to lessen the tugs on the skin. There is adhesive spray or wipes avaibale to use. 1.
Ask the patient if they would like to do it themselves. 2.
Ask the patient if they prefer to be distracted or want to watch the dressing change.
EDUCATION RESOURCES
In the event that a patient receives a new diagnosis and has questions/concerns that cannot wait until the CLS is in, some helpful education resources are: kidshealth.org Simply Sayin’ App Prep books can be found on iPad in iBooks
P2 PLAYROOM
Patient must be accompanied by an adult (caregiver, volunteer, CLCAT member) at all times 1. Any used toys must be cleaned. 2. Playroom must be thoroughly wiped down after each session. 3. Masks must be worn at all times when in the playroom. 4 Only one patient allowed in the room at a time. 5. Key for playroom is located in the suite (Key 62H4) and should remain locked when not in use. 6.
Developmentally appropriate activities and resources for patients are located in the Lion’s Den.
Duration: > 30minutes
This can be very intense to witness.
Patient is sedated for intubation.
Caregivers are not allowed in the room. It is very important to provide caregiver support rather than staying at bedside.
It can be helpful to play music for the patient during intubation.
CHESTTUBEREMOVAL
Adhesive removal options
CHEST TUBE INSERTION
Duration: >30 minutes
Patient is in a conscious sedation; patient is awake with their eyes open, but they are unaware of what is happening.
No pain is felt during this procedure.
helpful.
Duration: ~30 minutes
Patients have expressed that this feels like a relief.
Very helpful for the patient to hum while exhaling.
This procedure is not very painful, but the anticipation is where the pain builds up.
LINE/PICC LINE PLACEMENT Sterile procedure
Caregiver is not allowed at bedside.
Duration: >30 minutes
Patients are typically put under anesthesia via IV. If not given anesthesia, patient will be under a local sedative.
Most helpful to provide distraction at bedside until patient is unconscious and procedure is about to begin.
HEART TRANSPLANT
Leading up to this moment, the patient, caregivers, CCLS, and medical team have most likely already had conversations regarding this procedure. 1.
Most important thing to note is that the patient will come back without a VAD, which is something they have had for a while. A VAD is a ventricular assist device; it helps with heart function until a patient receives the heart transplant. 2.
Families have been awaiting this moment for quite some time, so it is worrisome and relieving. 3.
PCICU
Important to keep in mind that this unit consists of mostly infants!
EMOTIONAL SUPPORT FOR FAMILY MEMBERS
Validate the “good” and “bad” emotions.
Guilt for having to take a heart from another child to help their child survive.
Gratitude and happiness that the moment they’ve waited for is finally happening.
Anxiety and worry for a successful surgery.
PCICU RESOURCES
Mobiles, aquariums, and other developmentally appropriate resources are located in the Lion’s Den.
ECMO(EXTRACORPOREAL MEMBRANEOXYGENATION
1.
Life support measure that temporarily takes over the function of the patient’s heart and/or lungs.
2.
Surgical procedure that can be done at bedside or in the OR.
Typically done in emergencies. 3. Patient is intubated during or after the procedure. 4. Patient will be sedated, so caregiver support is crucial. 5.
6.
Length of time on ECMO varies by case, but sometimes patients can be taken off a few weeks later.
VAD
EMERGENCY SIBLING VISITS
Duration: 30 minutes
Must make sure to receive vaccination records prior to the visit. Have the caregiver send records via email and pass on to the NICU front desk. 1. Siblings must be masked at all times.
3.
2. You must be present for the duration the sibling visit.
There is a prep book and medical doll for play under kitchen sink in the Zone. The prep book has images of equipment that the sibling might see in the room or on the patient.
Take photos on the camera of the sibling visits so Katie can send to the family.
HAND HYGIENE
Make sure to use hand sanitizer before entering any room and immediately after leaving any room. Masks should always be worn at all times when entering any patient room.
NICU
HELPFUL/COMMON PHRASES TO USE WHEN MEETING WITH ICU FAMILIES
Ask them how they picked their child’s name. 1. Ask them their preferred coping. 2. Ask them what their child was like outside of the hospital (not applicable to NICU). 3.
5.
4. Caregiver support is crucial during this time.
Provide words of encouragement and remind them how great of a job they are doing.
JELTRATE MOLDS
*Best done with 2 people.
This is a 2 part process: jeltrate (done in the patient’s room) & plaster (done in kitchen)!
Instructions are located in bin in suite.
Keep in mind the temperature of the water when making the jeltrate!
Cold water= long time to harden
Warm water= hardens super quick!
When making the jeltrate, make it more chunky than smooth to prevent running and smoother operation.
Do not push hands or feet into mold too hard, you don’t want it to touch the bottom of the tray
After pouring plaster into the mold, make sure to get all air bubbles out You can tap the sides of the container or use the tool, but it is best to not lift the container off of a flat surface once the plaster is poured. Wait 24 hours before removing the mold from the container.
INK PRINTS
Located in bin in suite.
Use black disposable ink pads.
MEMORY BOXES
Located in suite or storage closet in NICU
Bereavement
Remember to only offer what you can do! Also, keep in mind that any Medical Examiner cases must have Legacy Building cleared by the medical team. Before beginning any bereavement services,youmustreceive parentalconsent. If parents choose services, give them the choice of involvement and what that can look like for them
FINGERPRINT CHARMS
*Can be done for Medical Examiner cases.
There is a binder on the shelf in the suite with the instructions.
Push hard for this mold, you should see a full and detailed fingerprint.
Make sure to fill out the form in the binder and put everything together in the pre-addressed envelope Ask the family to confirm their address, sometimes Epic is incorrect!
Offer the family a stone that they can place with the child and can then be given to the families later on.
The memory box can be used as a gift given to families that holds all the memorabilia created. Some families do not prefer the look of the memory box and might prefer a plain cardboard box Ask them what they would like
INKLESS PRINTS
Located in bin in suite.
Not a messy service to offer, easy clean up. Can be done for Medical Examiner cases.
DRAIN PULLS
DURATION: ~10 MINUTES
Hardest part for the patient is removing the bandages Ask if they would like to remove the bandages themselves and allow them some choice in the situation!
2.
Adhesive wipes or spray are available to assist with the bandage removal. Nurses and the team that comes to do the drain pull should have these items
There is normally 1 stitch that holds the drain This needs to be cut with scissors.
Drain removal process is very quick. This is not a painful process; most patients report that it is a weird, strange feeling/new sensation. 4.
Once the drain is removed, a new dressing is placed over it with some new bandages
Distraction is very important! Try blocking the vision of the patient so that they don’t have to watch the drain removal. 6.
Use an iPad and put it near the patient’s chest to block their view a.
Talk with patient, play music, etc b
BLOOD DRAW
DURATION: ~10 MINUTES
Tourniquet will be placed on upper part of arm. 1. Nurse will feel for vein. 2.
Once vein is found, nurse will clean the area with a cold alcohol wipe.
Needle will be inserted into vein and blood draw will begin.
Offer the patient the option to be distracted or watch.
Can use freeze spray or buzzy Freeze spray can be sprayed once area is cleaned, right before needle. Buzzy can be held at upper part of arm.
LUMBAR PUNCTURE
DURATION: >1 HOUR
IV PLACEMENT
DURATION: ~10 MINUTES
Tourniquet will be placed on upper part of arm. 1.
Nurse will feel for vein
Once vein is found, nurse will clean the area with a cold alcohol wipe. 3
Needle will be inserted into vein. Once insertion is successful, needle is removed and patient is left with a tiny tube in their arm.
4. Distraction is very important- ask the patient if they want to watch, suggest comfort hold with caregiver, play something on the iPad
5. Freeze spray and buzzy can be used. Freeze spray can be sprayed once area is cleaned, right before needle Buzzy can be held at the shoulder 6.
EEG PLACEMENT
DURATION: ~30 MINUTES
Stickers are placed on the patient’s head and wrapped with gauze. 1. Distraction is very important for the patients. 2. Patients must stay at the hospital for 24 hour video observation. 3.
with their spine curved
will receive one shot of lidocaine in their back, does not feel comfortable
The patient will then receive another needle in the back to remove the spinal fluid The spinal fluid gradually comes out, making the process lengthy
Once the fluid is collected, a Band-Aid is placed on their back
their back to monitor for any headaches for about an hour after procedure
Common question: Is it blood that they’re taking out? No, it is a clear liquid.
MOVIE GOGGLES
For inpatient MRI’s only!
Make sure the system is turned on [flip switch in back on right side, make sure 2 lights are lit up on the machine, and turn on monitor with big middle button].
Netflix & Disney+ are available. DO NOT SIGN OUT OF THESE ACCOUNTS!!!!!!! 3.
Patients are able to watch a show or movie for the duration of the imaging. 4. Headphones go over the ears, can also give the patient orange earbuds for extra noise cancellation. 5.
Goggles go over the eyes and get taped down to the headphones so they don’t fall off.
MRI (MAGNETIC RESONANCE IMAGING)
Make sure these lights are on
DURATION: ~1 HOUR
Patient has to lay down on the table during imaging.
Most important thing it to stay still and not move at all!
If contrast is needed, the patient should not feel anything. Contrast is given via IV.
One caregiver can be in the MRI imaging room, cannot be pregnant.
No electronics or metal allowed in the room.
The imaging is very loud and long.
Prep book is available on iPad in iBooks.
DURATION: 10-20 MINUTES
Patient has to lay down on the table during imaging.
Most important thing is to stay still and not move at all!
If contrast is needed, it might feel warm/burn and make the patient feel like they have to pee. Contrast is given via IV.
One caregiver can be in the room, must wear lead due to exposure to radiation and cannot be pregnant.
The imaging is fairly quick and does not produce much noise.
iBooks.
CRASH CART
1.
2.
This should be checked every morning.
Open the red binder on top of crash cart and check each box.
Green & Yellow lock- Ensure they are still in tact on 1st & 5th drawers. Write the corresponding number & expiration date. Ensure O2 tank reads full. Make sure there are 3 ambu bagsAdult, Pediatric, & Infant.
Make sure back board is on back of cart.
ECG N/A
Turn suction machine on to ensure it is working properly by pressing power button machine.
Defib instructions are on top of cart. Repeat twice, once plugged in and once unplugged.
AED N/A
Intubation box N/A
Remember to sign & date the defib print out sheet on the back and attach to the back of the checklist. 3.
KEYS
Keys are located in the drawer by chair and are all labeled. There is also a copy of keys in the key bucket in the suite.
TEEN SIDE TV’S
These tv’s are for gaming only. 1. TV1: PS5-HDMI1 2. TV2: PS5-HDMI1 or Nintendo Switch- HDMI2 3. Sometimes games won’t load, that’s normal! Try to redirect patient to a new game instead. 4. You can use the remote that turns on the art area TV to turn on the teen TV’s. 5.
TOYS
Toys from the zone must stay in the zone. Any used toys or materials must go in the bin to be cleaned.
MUSIC
The screen located on the wall underneath the COOL KIDS neon sign plays music on Spotify. The passwords of login to the device is:
Green & Yellow locks
Suction machine
Defib machine, instructions on top of cart Ambu bags, Oxygen tank
