Kierstin Connelly intern resource guide

ROTATING WEEKEND RESOURCE GUIDE

TABLE OF CONTENTS

Index P2 Hem/Onc PICU PCICU NICU Bereavement P5/P4S Radiology Zone

Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11

INDEX Blood Draw Central Line Chest Tube Insertion Chest Tube Removal Crash Cart CT Scan Drain Pulls Dressing Change ECMO Education Resources (P2) EEG Placement Emergency Sibling Visits Emotional Support for Caregivers Fingerprint Charms Hand Hygiene Heart Transplant Ink Prints Inkless Prints Intubation IV Placement Jeltrate Molds Keys (Zone) Lumbar Puncture Memory Boxes Movie Goggles MRI Music P2 Playroom PCICU Resources PICU Resources Port Access Teen Side TV’s Toys (Zone)

Page 9 Page 5 Page 5 Page 5 Page 11 Page 10 Page 9 Page 4 Page 6 Page 4 Page 9 Page 7 Page 6 Page 8 Page 7 Page 6 Page 8 Page 8 Page 5 Page 9 Page 8 Page 11 Page 9 Page 8 Page 10 Page 10 Page 11 Page 4 Page 6 Page 5 Page 4 Page 11 Page 11

PORT ACCESS

Duration: <10 minutes

1. Emla and freeze spray can be used.

Emla should be applied ~30 minutes prior to procedure.

2. Sterile environment, caregivers can be present.

3. Nurse has to touch the port area to find the access point.

4. Clean site of port. Port will be accessed with a needle. a. ** There can be a single access or a double access, double access requires two separate needles.

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.

8. Nurse hooks up machine and patient will begin receiving chemotherapy.

DRESSING CHANGE Duration: 10-15 minutes

1. 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.

2. Ask the patient if they would like to do it themselves.

3. Ask the patient if they prefer to be distracted or want to watch the dressing change.

P2- Hem/Onc

Emla & Freeze Spray

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 1. Patient must be accompanied by an adult (caregiver, volunteer, CLCAT member) at all times 2. Any used toys must be cleaned.

3. Playroom must be thoroughly wiped down after each session.

4. Masks must be worn at all times when in the playroom.

5. Only one patient allowed in the room at a time.

6. Key for playroom is located in the suite (Key 62H4) and should remain locked when not in use.

PICU

PICU RESOURCES Developmentally appropriate activities and resources for patients are located in the Lion’s Den.

INTUBATION Duration: > 30minutes

1. This can be very intense to witness.

2. Patient is sedated for intubation.

3. Caregivers are not allowed in the room. It is very important to provide caregiver support rather than staying at bedside.

4. It can be helpful to play music for the patient during intubation.

CHEST TUBE REMOVAL

Adhesive removal options

CHEST TUBE INSERTION Duration: >30 minutes

1. Patient is in a conscious sedation; patient is awake with their eyes open, but they are unaware of what is happening.

2. No pain is felt during this procedure.

3. Talking can be helpful.

Duration: ~30 minutes

1. Patients have expressed that this feels like a relief.

2. Very helpful for the patient to hum while exhaling.

3. This procedure is not very painful, but the anticipation is where the pain builds up.

CENTRAL LINE/PICC LINE PLACEMENT

Duration: >30 minutes

1. Sterile procedure 2. Caregiver is not allowed at bedside.

3. Patients are typically put under anesthesia via IV. If not given anesthesia, patient will be under a local sedative.

4. Most helpful to provide distraction at bedside until patient is unconscious and procedure is about to begin.

HEART TRANSPLANT 1. Leading up to this moment, the patient, caregivers, CCLS, and medical team have most likely already had conversations regarding this procedure.

2. 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.

3. Families have been awaiting this moment for quite some time, so it is worrisome and relieving.

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.

PCICU Important to keep in mind that this unit consists of mostly infants!

VAD

ECMO (EXTRACORPOREAL MEMBRANE OXYGENATION 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. 3. Typically done in emergencies.

4. Patient is intubated during or after the procedure.

5. Patient will be sedated, so caregiver support is crucial.

6. Length of time on ECMO varies by case, but sometimes patients can be taken off a few weeks later.

EMERGENCY SIBLING VISITS Duration: 30 minutes

1. 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.

2. Siblings must be masked at all times.

3. You must be present for the duration the sibling visit.

4. 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.

5. 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 1. Ask them how they picked their child’s name.

2. Ask them their preferred coping.

3. Ask them what their child was like outside of the hospital (not applicable to NICU).

4. Provide words of encouragement and remind them how great of a job they are doing.

5. Caregiver support is crucial during this time.

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!

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, you must receive parental consent. If parents choose services, give them the choice of involvement and what that can look like for them

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.

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!

MEMORY BOXES Located in suite or storage closet in NICU. 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

P5/P4S

DURATION: ~10 MINUTES

1. 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.

3. There is normally 1 stitch that holds the drain. This needs to be cut with scissors.

4. Drain removal process is very quick. This is not a painful process; most patients report that it is a weird, strange feeling/new sensation.

5. Once the drain is removed, a new dressing is placed over it with some new bandages.

6. Distraction is very important! Try blocking the vision of the patient so that they don’t have to watch the drain removal. a. Use an iPad and put it near the patient’s chest to block their view. b. Talk with patient, play music, etc.

IV PLACEMENT DURATION: ~10 MINUTES 1. Tourniquet will be placed on upper part of arm.

2. Nurse will feel for vein.

3. Once vein is found, nurse will clean the area with a cold alcohol wipe.

4. Needle will be inserted into vein. Once insertion is successful, needle is removed and patient is left with a tiny tube in their arm.

5. Distraction is very important- ask the patient if they want to watch, suggest comfort hold with caregiver, play something on the iPad. 6. 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.

EEG PLACEMENT DURATION: ~30 MINUTES

BLOOD DRAW

DURATION: ~10 MINUTES

1. Tourniquet will be placed on upper part of arm.

2. Nurse will feel for vein.

3. Once vein is found, nurse will clean the area with a cold alcohol wipe.

4. Needle will be inserted into vein and blood draw will begin.

5. Offer the patient the option to be distracted or watch.

6. 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

1. Stickers are placed on the patient’s head and wrapped with gauze.

2. Distraction is very important for the patients.

3. Patients must stay at the hospital for 24 hour video observation.

DURATION: >1 HOUR

1. Typically done unsedated, depends on the patient’s age.

2. Caregivers are not allowed to be present.

3. Patient will have to lay on his/her side, with their spine curved.

4. Patient will receive one shot of lidocaine in their back, does not feel comfortable.

5. 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.

6. Once the fluid is collected, a Band-Aid is placed on their back.

7. Patient must lie flat on their back to monitor for any headaches for about an hour after procedure.

8. Babies- use sweet ease, soothing sounds, soothing touch 9. Teens- stress ball, iPad. 10. Common question: Is it blood that they’re taking out? No, it is a clear liquid.

Radiology

MOVIE GOGGLES 1. For inpatient MRI’s only!

2. 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].

3. Netflix & Disney+ are available. DO NOT SIGN OUT OF THESE ACCOUNTS!!!!!!!

4. Patients are able to watch a show or movie for the duration of the imaging.

5. Headphones go over the ears, can also give the patient orange earbuds for extra noise cancellation.

6. Goggles go over the eyes and get taped down to the headphones so they don’t fall off.

Click this button to turn on the screen

Flip the switch on the back to turn the system on

Movie goggles set up on a patient

Make sure these lights are on

MRI (MAGNETIC RESONANCE IMAGING)

DURATION: ~1 HOUR

1. Patient has to lay down on the table during imaging.

2. Most important thing it to stay still and not move at all!

3. If contrast is needed, the patient should not feel anything. Contrast is given via IV. 4. One caregiver can be in the MRI imaging room, cannot be pregnant.

5. No electronics or metal allowed in the room.

6. The imaging is very loud and long.

7. Prep book is available on iPad in iBooks.

CT SCAN

DURATION: 10-20 MINUTES

1. Patient has to lay down on the table during imaging.

2. Most important thing is to stay still and not move at all!

3. If contrast is needed, it might feel warm/burn and make the patient feel like they have to pee. Contrast is given via IV. 4. One caregiver can be in the room, must wear lead due to exposure to radiation and cannot be pregnant.

5. The imaging is fairly quick and does not produce much noise.

6. Prep book is available on iPad in iBooks.

CRASH CART 1. This should be checked every morning.

2. 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 3. Remember to sign & date the defib print out sheet on the back and attach to the back of the checklist.

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.

Zone Defib machine, instructions on top of cart Ambu bags, Oxygen tank Green & Yellow locks

Suction machine

TEEN SIDE TV’S 1. These tv’s are for gaming only.

2. TV1: PS5-HDMI1 3. TV2: PS5-HDMI1 or Nintendo Switch- HDMI2 4. Sometimes games won’t load, that’s normal! Try to redirect patient to a new game instead.

5. You can use the remote that turns on the art area TV to turn on the teen TV’s.

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: Openthedoor1184