Pediatric CCRN Review Blog

Transthoracic Intracardiac Catheters (TICs)

Nursing Practice with Transthoracic Intracardiac Catheters in Children: International Benchmarking Study (Lisanti, Fitzgerald, Helman, Dean, Sorbello, et al, 2019) is an article in the current 2019 issue of American Journal of Critical detailing a cross-sectional, descriptive study of nursing practice in infants and children with TICs seeking to define criteria for catheter insertion and removal, dressing care, flushing practice, securement, and mobilization of patients. Nurses participating in the study from 43 facilities (n=40) used TICs.

A review of the literature revealed that standard practices for management do not currently exist. The study of surveyed colleagues found that most institutions use TICs for blood administration and total parenteral nutrition (TPN). If the line was kept in greater than 5 days, it was more likely to be used for lab draws as well as blood product administration. Dressing changes are done every 7 days in 65% of the participating facilities. Unfortunately, only about half of the surveyed nurses reported that patients with TICs were mobilized out of bed.

The study was limited by reliance on self-reporting versus objective data. Ultimately, more research is needed to standardize management and improve outcomes.

Lisanti, A.J., Fitzgerald, J., Helman, S., Dean, S., Sorbello, S., & Griffis, H. (2019). Nursing Practice with Transthoracic Intracardiac Catheters in Children: International Benchmarking Study. American Journal of Critical 28(3). (174-181). Retrieved from doi:10.4037/ajcc2019350

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The May 2019 issue of Bold Voices highlights 3 American Association of Critical Care Nurses (AACN) chapters who have implemented strategies to increase the number of certified nurses, increase the renewal and retention of certified nurse, influence the preparation or ability of nurses to qualify for certification, and increase public awareness and promote the value of certified nurses. These chapters include the AACN Dallas County chapter, the AACN Houston Gulf Coast chapter, and the AACN Greater Raleigh Area chapter. The article goes on to discuss activities at the 2019 National Teaching Institute & Critical Care Exposition (NTI).

What does this mean for nurses seeking pediatric CCRN certification? The article does not mention any certification review courses for this exam. In fact, the number of pediatric CCRN qualified candidates is who tested in 2018 (1.562) is much lower than the number of adult CCRN candidates (15,609).

While the number of adult intensive care units (ICUs) in the United States (US) is definitely higher than the number of pediatric intensive care units (PICUs), the number of PICUs is has grown in recent years. I believe that the number of pediatric CCRN candidates tested remains low due to a lack of resources. A quick Google search for adult CCRN review courses yields many options, while the results for searching for pediatric CCRN review courses is limited, and most do not offer flexibility or self-pacing.

Pediatric CCRN certification offers so much more to the learner than merely the addition of letters behind one’s name. The investment in certification can lead to an application to certified nurse anesthetist (CRNA) school, nurse practitioner (NP) school, and/or a promotion into a leadership or teaching role. And most importantly, it improves the outcomes of patients, which is the real reason we do what we do everyday.

https://www.aacn.org/certification/preparation-tools-and-handbooks/exam-stats-and-scores

http://www.nxtbook.com/nxtbooks/aacn/boldvoices_201905/index.php#/6

Photo credit: https://ww2.mc.vanderbilt.edu/nepd/44428

Are you going to NTI this year?! If so, congrats! The conference offers a wealth of information, networking, and inspiration. I am sad to say that I will be unable to attend at 34 weeks pregnant, but I wanted to ensure that anyone going has checked out the available resources! The May 2019 issue of Bold Voices has a great article called Top Tips for the Best NTI Experience found here → http://www.nxtbook.com/nxtbooks/aacn/boldvoices_201905/index.php#/4

You don’t want to get lost in the magnitude of the conference! The article suggests perusing the frequently asked questions page at www.aacn.org/nti, as well as using the My NTI tool to create a schedule and plan your week. Sunrise Sessions are available, but require a reservation. The NTI Program Planning Committee will be chairing “Navigating NTI 101” on Sunday, May 19 at 1615 or Monday, May 20 at 0800 to offer suggestions on how to make the experience the best for you. If you’re staying and making a vacation out of the conference, www.visitorlando.com  highlights the amusement parks, cultural activities, and outdoor activities. And don’t miss the Nurses’ Night Off at Univeral Studios Florida on Wednesday, May 22 from 1930-2300! One complimentary ticket is included with your NTI registration.

If you get there early, it is recommended to tour and familiarize yourself with the convention center to maximize navigation of key places. Another tool provided on www.aacn.org/nti is the Learning Action Journal, which can also be found in your attendee bag. As with any conference, it is recommended to dress comfortably and to plan for either bringing your own or purching meals, snacks, and water for breaks throughout the day.

http://www.nxtbook.com/nxtbooks/aacn/boldvoices_201905/index.php#/4

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Happy Nurse’s Week everyone!

This time of year (May 6th-12th) nurses are recognized nationally for their hard work, passion, and service. Plus there’s a lot of free stuff! This website https://gimmiefreebies.com/national-nurses-week-nurse-appreciation-week-freebies-deals/ lists fun freebies for nurses from a free 16 0z. Dunkin’ Dark Roast iced coffee May 6-12, between 4 p.m. and 10 p.m. with a valid health care ID to a free Cinnabon® Classic Cinnamon Roll, MiniBon®, or 4-count BonBites™ when nurses show their healthcare ID badge. While Chipotle is NOT offering their BOGO deal for nurses this year, participating Chipotles are offering medical professional BOGO 50% OFF every Wednesday!

So what about Pediatric CCRN Online Review? Nurses Week is coming early! Now through May 12th, we are offering $75 off our full online program with code NursesWeek2019 and $20 off our online practice questions with code NursesWeek2019Questions!

Nurses who invest in their careers will always benefit. Pediatric CCRN certification is often pursued by nurses before applying to CRNA, NP school, or a promotion. More importantly, certification improves the outcomes of our patients. And isn’t that why we became nurses?

Photo credit: https://gimmiefreebies.com/national-nurses-week-nurse-appreciation-week-freebies-deals/

Arteriovenous malformation (AVM) is an abnormal connection between the arteries and veins in the brain, making it the most common cause of intracranial hemorrhage in children. Treatment options include surgery, radiosurgery, and irradiation depending on the patient’s condition. Dilated pupils and nystagmus are not symptoms of AVM. Seizures are seen if the AVM has hemorrhaged. 

AVM places patients at risk for hemorrhage and rebleeding after surgery. Signs and symptoms of hemorrhage include severe headache, seizures, decreased level of consciousness, hypotonia, irritability, decreased hemoglobin, and abnormal eye movements in a patient that is slowly deteriorating. Signs and symptoms in a rapidly deteriorating patient include coma, apnea, seizures, and unreactive pupils. Creating a calm environment keeps intracranial pressure (ICP) low and decreases vasospasm. 

The cause of congenital neurologic abnormalities is unknown. A ventriculoperitoneal shunt may be indicated if hydrocephalus is present to decrease intracranial pressures. Nursing diagnoses include potential for infection after surgery, potential for decreased cardiac output related to anaphylactic shock from latex hypersensitivity, altered cerebral tissue perfusion related to increased ICP due to hydrocephalus, and altered elimination related to decreased innervation of bladder, urinary sphincter, and lower intestines.