PICUfamilyguide-parentinformation.pdf

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Paediatric IntensiveCare Unit

Inormation or amilies


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Paediatric Intensive Care Unit Paediatric Intensive Care Unit 3

We hope this booklet will help you understand more about ourspecialist Paediatric Intensive Care Unit (PICU) and the team who will becaring or your child.

I you have any questions that are not answered, please talk to any membero sta on the unit.

In the PICU, sta and parents work together. This means we are open andhonest with each other, share inormation reely and make decisions together.

Being a parent in the PICU

For your child, you are the most important person o the team. No-one elsecan oer your son or daughter the comort o his or her own amily. Even iyour child is asleep or unable to move because o tubes and machinery, thereare still ways to ulll your role as a parent.

Your child will gain much comort rom the touch o your hand, the sound oyour voice and the amiliar ways that you help him or her through ear andpain. Children who are asleep still eel the comort o a loving presence.

With newborns, being in the PICU can interere with those precious earlydays when you get to know your child.

It is important to nd ways to introduce yoursel to your baby. Babies learn torecognise voices rst and your voice will be the one constant or your baby.

Visiting

You can be with your child as oten as you like - we do not regard parents asvisitors on the unit.

Because the PICU is an open and busy area, we have guidelines or peoplecoming on to the unit:

Please call via the intercom outside the door beore you come in. Ournursing sta are likely to be busy caring or the children so bear with us ithe door is not always answered immediately.

Let sta know i it is your rst time on the unit. A member o the team willhelp you get acquainted with the new surroundings.

Children may nd the PICU a daunting place at rst, so eel ree to ask yourchilds nurse to work through any issues that may be concerning them.Sometimes it can be helpul to involve one o our clinical psychologists insupporting you and your child in adapting to a stay on the unit.

Please remember to supervise your other children while they are visitingthe unit.

We recommend that only two or three people visit at any one time butthere are occasions when we can make exceptions. Please speak to thenurse looking ater your child about this.

Inections spread quickly and are more dangerous to children who are verysick. For the protection o all children on the unit, anyone who is sick orhas been in contact with an inectious person is asked to stay away.

Handwashing is extremely important in the hospital please talk to staor advice.


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Routines in the PICU

A typical day in the PICU might be along these lines:

8amNurses rom the night shit report to the day nurses.

8.15am to 8.45amNurses carry out a saety check on equipment and examine your child.

8.30am to 9.30amThe doctors, nurse in charge o the shit and other members o the team gettogether to discuss your childs progress and ongoing treatment. This

meeting takes place outside the unit. A doctor is allocated to look ater yourchild or the day.

9.30am onwardsTreatments and tests are carried out. This is an opportunity to discuss anycare your child is receiving. The nurse can then share this inormation withother members o the team.

12pmMicrobiologists visit the unit and discuss with your childs doctor anynecessary treatments to treat inection.

2pm to 3pmI possible, we try to have a quiet time. This is when the lights go down,noise is kept to a minimum and procedures avoided wherever possible.

4.30pm to 5.15pm

PICU doctors visit each child to evaluate daily progress and plan care or thenight with other team members. This takes place at the bedside and you areencouraged to stay with your child during the ward round.

8pmNurses rom the day shit update those on nights.

10pm onwardsChildren are given as much rest as possible but intensive care continuesthroughout the night.

Taking care of yourself

Regardless o whether your stay is likely to be long or short, it is importantor your childs well-being that you take good care o yoursel.

Our tips include:

Taking occasional walks.

Eating nourishing meals.

Trying to get at least a ew hours o rest every day.

Take a break with a riend who is a good listener.

Remember people outside the hospital are oten keen to help.

It may be helpul to meet with one o our clinical psychologists to talkthings through. Please ask a member o sta i you are interested.

I you are breasteeding or plan to breasteed your baby, inormation isavailable rom your childs nurse. You can also see our inant eeding specialist.


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Fire safety

I our re alarms are activated, we ask parents and visitors to wait outsidethe hospital and await urther instructions. Sta will be kept updated bythe re brigade

People in PICU

While your child is on the unit, you and your amily will come intocontact with many dierent people who are all part o the intensivecare team.

Consultant intensivists are specialists in critical care and in charge o theday-to-day medical care o children on the unit.

Assisting them are registrars and senior house ofcers (SHOs), who aredoctors gaining additional experience with the care o critically il l children.These doctors watch your childs condition and treatments closely and keepyou and their consultant or surgeons updated with any changes.

Matron, who wears a purple uniorm, has overall responsibility or PICUnurses and the ward environment.

Sisters or charge nurses co-ordinate and supervise the care provided bynursing sta on each shit.

Nurses care or your child on the unit. Working with amily members and therest o the team, the nurse helps to meet a childs physical and emotional needs.

Our nurses write an individual care plan or each child, which you can discussto ensure it works best or your son or daughter.

Clinical psychologists are available to provide additional emotional support

to amilies. As well as oering individual time with parents, siblings andother amily members to work through their experiences, they are availableto support communication and achieve shared understanding with themedical team.

Support workers assist nursing sta caring or the children and help withthe smooth running o the unit.

Physiotherapists assess your childs breathing and help to keep his or herlungs clear. This can involve anything rom encouraging breathing exercisesto specic chest physical therapy treatments. They also help to prevent jointstiness and muscle weakness with gentle exercise.

Sometimes the physiotherapist will need to help your child start movingagain. They also assist in encouraging your childs normal development andmovement through individual activities, and sometimes with the aid ospecial equipment.

Social workers are available to provide support and counselling to amiliesas they cope with the social, emotional and practical impact o their childsinjury or lie-threatening illness.

Dieticians make sure your child is receiving the necessary nutrition or his orher medical condition, and or growth and development. Some patients inthe PICU are on reduced amounts o fuid, so the dietician can suggest wayso providing adequate calories in smaller volumes.

Pharmacists visit the unit every day to discuss your childs medication withthe doctors and nurses.

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The lecture practitioner is responsible or on-going education or critical carenursing. You may see him or her working alongside nurses with your child.

The research and audit sister or charge nurse is one o the clinical nursesinvolved in promoting research on the unit. Research is important to ensurethat we are always providing the best care or the children. You may beinvited to participate in one o these studies.

Specialist nurses are highly trained in specic areas o nursing and may beasked to visit you and your child during your stay. They may be linked to aspecialist ward, which your child has either come rom or is likely to bemoved to.

Technicians play an important role with equipment used in the PICU. Theywill ensure that the equipment being used or your child is in top conditionand help move children who require scans or transportation with monitoringand ventilation.

Spiritual care

Hospital chaplains are on call 24 hours a day, seven days a week, and oerspiritual comort and support to patients and amilies o any aith, traditionor spirituality.

The chaplain will listen to any concerns, oer emotional support, help youexplore dicult questions and issues o grie and loss, oer spiritual supportand prayer, provide prayer books or sacred text or reading, or contact a localminister or spiritual leader o your aith.

Any member o sta will be able to contact a chaplain or you. In specialcircumstances, a christening or other religious ceremonies can be arrangedon the unit.

Alternatively, your own religious leader is welcome to visit your child at any time.

You can nd the hospital chapel by turning right outside the PICU, ollowingthe corridor towards the lits and heading towards the doorway on the right(marked Stairs). Cross over the staircase and continue through the doubledoors, down the corridor and you wil l nd the chapel.

Equipment in the PICU

Some o the medical equipment on the unit can appear quite dauntinguntil you know more about its unctions.

All our children are connected to machines that bleep and alarm requently,and our sta understand these sounds and know how to respond.

During your childs stay on the unit, you will learn more about these machines butplease ask the sta i you have any questions.

Some o the more common pieces o equipment include:

Heart and breathing monitor: This is a screen that gives a picture recordingo your childs heart and breathing patterns. The monitor is linked to yourchilds chest with a thin wire and three to ve electrodes. These stick to thechest like plasters.

Endotracheal tube (ET tube): This is a tube through the mouth or nose thatis connected to a breathing machine to help send oxygen to the lungs. Thetube passes between your childs vocal chords and, because o this, he or shewill be unable to speak or cry until it is removed.

The tube is taped to your childs ace to keep it in place, and these tapes arechanged rom time to time as needed.

When the tube is in place, the child will also be unable to cough up anymucus rom the lungs.


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Paediatric Intensive Care UnitPaediatric Intensive Care Unit 11

The nurse clears mucus out o the tube by putting a thinner tube into it andapplying suction (called suctioning). A small amount o normal saline (saltywater) can be put down the tube to loosen secretions.

Saline and suctioning may make your child cough.

Placing an ET tube is known as intubation and a child with an endotrachealtube is intubated. When the tube is removed, it is called extubation.

Ventilator: This machine helps your child breathe. It delivers air, with theright amount o oxygen, through the ET tube into the lungs.

Saturation monitor: A special light probe placed on a toe, oot or nger used

to measure the oxygen saturation o the blood.

Nasogastric tube (NG tube): This tube is passed through the nostril or themouth into the stomach, and drains air and fuid to help breathing andprevent vomiting. The tube can also be used to give eeds and medicines.

Chest drains: These are plastic tubes that drain air, blood or fuid rom thearea around the lungs or heart.

Oxygen mask/head box/nasal prongs: These are ways o giving oxygen tothe lungs without intubation.

Urinary catheter: This tube is placed through the urinary opening into thebladder to empty urine rom the bladder into a collection bag.

Central line: This is a tube placed in a major vein in the neck or groin. Thistype o line allows us to give stronger medications that might harm a childssmaller blood vessels. These lines can also be connected to the monitor to

measure the amount o blood fowing into the heart.

Intravenous line (IV): Intravenous means into a vein. An IV is a small tubeplaced into a vein and connected to longer tubing through which fuid,nourishment and medications can be given, usually using special pumps. AnIV may need to be replaced rom time to time.

Arterial line: A thin tube placed into an artery (usually in the arm, groin oroot). The line is joined to a monitor and allows us to read blood pressurewithout disturbing the child. Blood samples are taken rom the tubing tomeasure important levels like oxygen and carbon dioxide.

Medications

Your child may be given a variety o medications while they are apatient on the unit. Some o the drugs that may be used include:

Pain relievers (analgesics): There are many drugs available that help withmanaging pain. The two main types are opioid, such as Morphine andFentanyl, and non-opioid, such as Paracetamol.

Usually, the opioids are given with an intravenous (IV) pump. The doctors andnurses taking care o your child control the amount o the drug given and

assess your child continuously to determine how he or she is eeling.Older children may receive the drugs through an IV pump called a patientcontrolled analgesia (PCA), which gives your child control over the amount omedication he or she receives.

The pump is programmed to prevent too much medication being given.

Paracetamol can be given orally, oten through a eeding tube. Occasionally,it may be given as a suppository rectally.

Paracetamol is also given as an antipyretic, a drug that assists the body inlowering its temperature.

It is important to know that your child will not become addicted tomedication given to relieve pain. The drugs are used to keep children ascomortable as possible and assist them to get better.

Sedatives: In addition to pain relievers, your child may receive sedatives,which are medications to relieve anxiety.

In the PICU, the most requently used is Midazolam, which is givenintravenously when required. Other common sedatives used areChloralhydrate, Vallergan and Clonidine.

Diuretics: While on the unit, your child may be given medications to helpthem get rid o extra fuid or to help their kidneys work better. These drugsmay be given as one-o doses or more regularly.


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In some instances, they are given as continuous IV inusions. Frusemide andSpironolactone are examples o diuretics.

Muscle relaxants: Suxamethonium, Vecuronium and Atracurium are exampleso muscle relaxants used in the PICU.

These drugs may be given to your child to prevent him or her rom moving.

You may hear this called paralysis but please be reassured that this istemporary. Your child will be sedated while on these drugs.

Heart medications: Many dierent types o medications are available tohelp the heart work at its best. In the PICU, your child may receive one ormore o the ollowing:

Inotropes (support drugs) are a type o medication that support the heart andare given on a continuous basis and controlled at a certain rate by an IV pump.

One group helps by making the heart pump blood out with a stronger, moreeective orce, usually also increasing your childs heart rate and blood pressure.

I your childs heart needs some assistance beore or ater surgery to pumpblood well, one or more o these drugs may be given Dopamine,Dobutamine, Adrenaline, Noradrenaline and Milrinone.

Another group o support drugs are called Vasodilators. These drugs may beused beore or ater surgery to help the heart by decreasing the orce needed toget blood out to the body. They also lower your childs blood pressure. The nameso commonly used drugs are Labetalol, Glyceryl Trinitrate (GTN) and Nitroprusside.

Anticoagulants (blood thinners): Sometimes children require medicationsto thin their blood and prevent blood clots rom orming. These drugs arereerred to as anticoagulants.

Heparin and Wararin are the most common anticoagulants. Heparin is commonlygiven as an IV inusion. It can also be given as an injection, requiring a ne needleto be inserted under the skin surace. Wararin is given in liquid or tablet orm.

Bronchodilators (breathing medications): Your child may need medicationto help keep his or her airway open. Swelling o the airway is common inchildren due to asthma, inections or trauma.

The medications most oten used in the PICU are Salbutamol, Aminophyllineand Adrenaline.

Antibiotics: When your child is admitted to the unit, he or she is monitoredor inection. I the doctors suspect an inection, they may start antibioticsthat cover most types o inections.

Once the tests have conrmed a certain cause or the inection (usuallybetween 12 and 24 hours), the doctors may change the antibiotics to treat

the specic bacteria or stop it i there are no signs o inection.

Anticonvulsants: Some children have convulsions (ts) due to ever, inectionor trauma, but others have them and we never know why.

When a child is admitted to the PICU with ts or has had one on the unit,medication is given to either stop or control it.

The most common anticonvulsants used are Phenobarbitone and Phenytoin,which can be given by mouth, as a single IV dose or by a continuous IVinusion. Sometimes Diazepam is given to stop convulsions that continue ora long time. This can be given intravenously or rectally.


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Paediatric Intensive Care Unit 15Paediatric Intensive Care Unit

Family resources

Our parents accommodation, across the main corridor rom the PICU,is equipped with a kitchen, television lounge, waiting room and toiletsor your use.

I you are staying here, ask or a tour and let our sta know i you have anyquestions.

Our housekeeper will oversee the day to day running o the accommodation,including topping up o tea, coee, milk and sugar.

We recommend that you keep your door locked at all times, even when youare inside your room. Please leave your bin outside i you would like it to beemptied.

Arrangements can be made via your childs nurse to have your room cleaned.

Any ood kept in the ridge or reezer should be labelled.

Room availability is reviewed on a daily basis, and it is possible that you couldbe asked to move to alternative accommodation i there is a greater need oranother amily.

A playroom is located in the PICU waiting area. This is kept locked or saetyreasons but the key is available rom sta. We ask that any play is supervised.

The Eaterie, the hospitals restaurant or patients, visitors and sta, can oundon B level. Discount vouchers are available or amilies rom our nurses.

There are also other ood outlets in the hospitals main entrance area onC level.

Breast pumps are available or mothers who wish to breasteed.

Free meals or breasteeding mothers can be delivered direct to the unit untilyour baby is ten days old. Please arrange this through your babys nurse.

Parking discount vouchers are available or amilies again, please ask yourchilds nurse or details.

We will do everything possible to make your stay in our parentsaccommodation a comortable one and remind you to consider otheroccupants while you are with us.

Any eedback about what we are doing well or what could be improved willbe welcomed.

Please speak to the matron or ll out and return a eedback orm availablerom the hospital main entrance.

Alternatively, contact us via the Trusts website www.suht.nhs.ukor email [email protected]

Transferring to the ward

When your child is well enough to leave the PICU, he or she will betranserred to one o the hospitals wards.

This new environment may eel very dierent at rst, as there will be lessmonitoring and the nursing sta will have more than one patient to look ater.

Due to limited accommodation, only one parent can stay with their child onthe ward.

Please ask i you have any questions.


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Paediatric Intensive Care UnitLevel DCentre Block

Southampton General HospitalTremona RoadSouthamptonHampshireSO16 6YD

Telephone: 023 8079 6972

www.suht.nhs.uk

Version 1. Published December 2010. Due or review December 2013

PICUfamilyguide-parentinformation.pdf

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