Background

Whilst clinical cyanosis is well recognised and treated, congenital methaemoglobulinaemia is rare in children and even more uncommon in the newborn. Cyanosis in the newborn is often associated with sepsis, congenital heart defects or respiratory abnormalities. After birth, the newborn undergoes a normal transition of cyanosis both physical and on oxygen monitoring which is due to the normal adaptive mechanisms of the circulation. In these cases, with immediate intervention the outcomes are usually favourable. In the case of methaemoglobin abnormalities, early detection can be challenging but it is vital to investigate promptly and avoid delay in treatment as long term effects can be deterimental.

Objectives

There is paucity of knowledge in literature regarding methaemoglobulinaemia.

We present a case of a newborn who developed cyanosis within the first hour of life and was treated appropriately for presumed infection. Despite appropriate oxygen administration, by day 10, the baby remained blue with good oxygen saturations. On further review, it was noted that he had raised methaemoglobin in the blood gas.

Methods

This is a case based report.

Results

Following referral to a tertiary centre and red cell gene panel testing, he was consequently found to have two heterozygus mutations of the enzyme cytochrome b5 reductase 3 of which one mutation has not previously been described and now is felt to be likely pathogenic.

Conclusion

Congenital methaemoglobulinaemia is a rare condition which warrants prompt diagnosis and treatment. Vigilence regarding this rare diagnosis is vital in a common presentation such as persistent cyanosis.

Background

Extravasation injury is a significant cause of morbidity and mortality in neonates due to their fragile veins and skin. Enquiry-based learning is a learning approach driven by students’ active engagement and enquiries to real-life situations. We adopt this new approach to enhance baccalaureate nursing students’ learning of prevention and management of neonatal extravasation injury.

Objectives

(1) To develop high-quality e-learning resources to facilitate students’ learning of prevention and management of extravasation injury, and (2) To determine students’ satisfaction with the learning resources.

Methods

We developed an e-learning platform that embeds 10 interactive activities covering essential topics about neonatal extravasation injury, including its contributing factors, complications, management, early detection and prevention. Each interactive activity consisted of 1) a scenario and 2-3 video clips based on real-life situations, and 2) critical-thinking exercises with online learning resources. An expert team of nurse academics, nurse consultants, registered nurses, pharmacists, and nursing students collaborated to develop the e-learning resources. Semi-structured interviews were conducted with the nursing students who participated in the production of the resources.

Results

The students commented that this approach promoted deep learning, enhanced critical enquiry and synthesis, and facilitated their application of knowledge and skills learned to real situations in clinical settings. They appreciated the opportunity to learn from nurse consultants and teachers during the process.

Conclusion

We adopted new pedagogical approach to sustain students’ active engagement in their studies. Further evaluation will be conducted to determine its impact on focus of learning and students’ knowledge and skills regarding administration and management of intravenous therapy.

Background

To achieve the goal we have introduced central venius catheter bundle:

Daily review of line necessity with prompt removal of unnecessary CVCs and documentation.

Objectives

1.management and monitoring central venius sepsisi

2. reduce them to 0

Methods

observing the work of people who handle with it

Results

Daily review of continued need for CVCs can be done in the following ways:

o During multidisciplinary patient care rounds
o By using reminders (such as stickers on patient records or order sets)

o Via automated computer alerts

Details of removal documented in the records (including date, location, and signature and name of operator undertaking removal)

Hand hygiene before manipulation of the IV system

Catheter injection ports:

· Open lumens (such as catheter hubs or stopcocks) are covered with needleless connectors.

· Access ports are sanitized with chlorhexidine

·Caps are changed no more often than 72 hours

Proper procedures for catheter site dressing monitoring/changes

·Change gauze dressing every 3 days or earlier if it need

Catheter access/manipulation

· Aseptic techniques are used for all access to the line.

· Catheter site care is performed with chlorhexidine at dressing changes.

In the absence of chlorhexidine, use povidone iodine.

· Ports or hubs are cleaned using protocol

Health care personnel training
·All staff members manipulating CVCs could be required to attend a hands-on training class in the proper techniques for caring for and accessing catheters

Conclusion

We can see that we have catheter sepsis because we admniistration

it and that with bundle we can reduce the number of it

Background

Time management in PICU can be challenging and affect staff morale.

Objectives

We identified that nursing handover and patient allocation can be improved, and a pre-allocation 6 month trial was set.

Methods

Initially, patients were allocated based on staff preference. In April 2018, we categorised nursing staff based on level of expertise and looked at nPA during the previous shift. Patients’ dependency level, nurse experience and skill mix were considered. Staff’s learning needs and continuity of care were taken into account.

Nurses were surveyed on their views of nPA both prior to implementation and 3 months after it.

Results

We obtained 69 responses (out of 120 nurses) in the initial survey. 50% of staff had not experienced nPA and raised concerns around freedom of choice. Nurses previously exposed to nPA were keen on its implementation.

61 responses were obtained in the 3-months survey. 98.3% of nurses reported positive feedback, with 86.6% willing to continue post trial. Reported benefits were: quicker handovers, leaving on time and varied learning opportunities. Areas for improvement were identified and optimised during the trial period. Allocation process was simplified through our electronic records system to allow quicker PA and increase continuity of care.

nPA has now been implemented as part of our standard of care.

Conclusion

Nurse pre-allocation has allowed staff to improve their time effectiveness and exposure to different caseloads without jeopardising continuity of care. Feedback allowed us to identify barriers for implementation, but also instigated improvements once implemented.

Background

- The laying-on of hands could strengthen the ‘human energy field’ maximizing healing and well-being. For centuries, physicians and other healers have witnessed how illness focuses attention on "ultimate meaning, purpose, and transcendence, and … relationship to self, family, others, community, society, nature, and the significant or sacred.” Patients often discover strength and solace in their spirituality, both informally through deeper connections with family and friends, and formally through religious communities and practices. However, modern day clinicians regularly overlook dimensions of spirituality when considering the health of others.

Objectives

Objectives- the aim is to demonstrate our multi-cultural, multi-religious practice of therapeutic touch during complex interventions (ECMO) as well as a wide spectrum of spiritual tools used in crises.

Methods

Methods- our PICU is the only level 1 center in a urban population of 1 million serving broad spectrum of religions and religiosities. The nursing team has developed extensive methods of using therapeutic touch during curative and palliative interventions. In addition, we have created a spiritual CPR wagon with amulets, spiritual talismans and religious charms, Jewish, Islamic and Christian prayer books in many languages, rosary beads, book of psalms and various other symbols.

Results

Positive and memorable feedbacks from the bereaved parents who used this tools

stuff self -satisfaction from having the honor to support the family in their most painfull moments of loss

Conclusion

Conclusions- Our experience in using therapeutic touch and spiritual symbols have enriched our practice, our ability to provide holistic care, and has elevated our practice to a higher dimension.

Background

A 3 month old with Netherton syndrome and chronic lung disease required a prolonged period of ventilation (including high frequency oscillation) for bronchiolitis. Netherton syndrome is an autosomal recessive disorder that affects the skin, hair, and immune system, infants with Netherton syndrome have skin that is red and scaly (ichthyosiform erythroderma). Due to the frequent application of emollients for his ichthyosis it became impossible to keep his oral ET tube secure with conventional trouser leg tape fixation, as no tapes would reliably stick to his skin. A variety of methods using fabric tapes were tried and were unsuccessful.

Objectives

After an unplanned extubation whilst on high frequency oscillation ventilation a safer method for securing the tube was required.

Methods

A nasogastric tube was passed via the nasopharynx and out of the mouth to create a bridle to secure the ET tube in position.

Results

This proved very stable with no movement of the ET tube and remained secure until the infant was ready for extubation. The child did not develop pressure marks on his skin or bleeding from the nasopharynx.

Conclusion

This method of securing the ET tube proved a secure and safe method for a child of this age group.

Background

The study of risk factors and early neonatal adaptation of full-term newborns born in a condition of hypoxia of varying degrees of severity.

Objectives

There were 49 patients and their children born in terms of 37-41 weeks in a state of hypoxia. 85.1% of puerperas were in the range from 18 to 35 years, 14.9% from 36 to 45 years.

Methods

When assessing the condition of newborns on the Apgar scale in children born at 37-40 weeks, 66.4% in the first minute and 16.9% in the fifth minute were diagnosed with mild hypoxia.

In children born at 40-41 weeks, in the first minute 33.1% were diagnosed with moderate hypoxia, and 44.6% - mild hypoxia. In the fifth minute mild hypoxia was diagnosed in 66.5%. The rest were in satisfactory condition. Among the complications of the early neonatal period of children born from 37 to 40 weeks was noted-cerebral depression syndrome in 20%, intrauterine infection in 17%, transient tachypnea-15%, congenital pneumonia-12%, jaundice – 5%. Early neonatal morbidity in newborns born in the period 40-41 week, presented: cerebral depression syndrome - 25%, congenital pneumonia - 17%, intrauterine infection - 17%, meconic aspiration - 9%, cerebral excitability syndrome - 8%, jaundice - 8% .

Conclusion

The structure of early neonatal morbidity varies depending on the timing of delivery. Cerebral depression syndrome, congenital pneumonia and jaundice were more often diagnosed at 40-41 weeks. The syndrome of meconial aspiration and cerebral excitability were detected, which were not in the terms of 37-40 weeks.

Background

Joana Pinto Silva: ICU Pediatric Nurse

Maria Clara Vital: Head Nurse

Objectives

The research aims to understand the needs of parents of children who undergo heart transplantation after returning home and how they self-manage their child’s complex care needs.

Methods

The study used a descriptive and cross-sectional design. After obtaining institutional review board approval, the parents or caregivers of children undergoing heart transplant have filled a questionnaire. The data collection was carried out on the follow up appointment in Pediatric Cardiology ward.

Results

It allows to identify which dimensions should be included by nurses when they start to prepare the discharge of children who underwent pediatric cardiac transplantation and their family.

When the nurse tries to identify the needs and difficulties felt by parents of heart transplant pediatric recipients, such as the preparation to return home, the return to daily life activities, and the management of medication and feeding, the nurse aims to continuously improve the quality of nursing care.

Conclusion

The challenge of pediatric nursing is in adding value to health quality, through a paradigm centered in the transition processes that children and their parents experience as a result of events in their health or incorporation of new roles, as is the case with pediatric cardiac transplantation.

The improvement of quality of nursing care predicates a reflection on and of said care, shared within the team and supported by references that showcase good clinical practices.

Background

Newborns with hospital discharge should be transported home in a proper and safe restraint system. In the NICU of a Portuguese University Hospital, the car seat challenge test is carried out since 2005, but there was not any study about its safety neither any protocol to guide its performance.

Objectives

To describe the development of an evidence based standardized procedure to perform the car-seat challenge.

Methods

A descriptive, retrospective, observational, non-experimental, study was carried out with data obtained from nursing records of car-seat challenge tests performed during the year 2015, and described elsewhere (Brás et al, in press). The results evidenced that 86 preterm infants were discharged home and all had values of SpO₂ and HR within reference range for this age group, and it was a safe.

The analysis of the procedure and the literature reviewed led to the development of a standardized procedure to perform the car-seat challenge.

Results

The standardized procedure has 3 sections: A -Equipment, B – Procedures (describing all the procedure, including when discontinuing of the test) and C – Parental education.

It was approved by the NICU direction and Acreditation Department of the Hospital and its implementation started in January 2019.

Conclusion

The standardized procedure for performing car seat challenge test in the NICU, is a result of the outcomes of the study performed as well as evidence obtained from the literature reviewed. It will be evaluated after a six-month testing period.

Background

Xenon (Xe) is a noble gas with anesthetic, analgesic, antistress and other characteristics. Data of therapeutic use in adult allow to predict positive effects in children with polytrauma.

Objectives

Estimate therapeutic effects of Xe in complex therapy of children with polytrauma.

Methods

We studied 7children 16 ± 1,5 years with polytrauma, ISS 30± 5. All suffered from chronic pain and insomnia. In addition to complex treatment Xe inhalations were assigned (Хе :О₂ = 20 – 30% : 50 – 30%), duration 15 – 20 min, 3 – 12 times. Xe console КТК - 01 (ООО «КсеМед», Russia), monitor - МР 60 (Philips, USA). We used Visual Analogue Scale (VAS), Ramsay scale, BIS index, cerebral oxygenation indicator to estimate an effect.

Results

The level of pain decreased (VAS) (4,1 ± 1,8 to 1,1 ± 0,4), after session 1,9 ± 1,1 (р< 0,05). The depth of sedation (BIS-index) decline from 95,5 ± 2,5 to 86 ± 5,0, then recovered 93,0 ± 2,1; Ramsay scale from 9,4 ± 0,5 to 2,7 ± 1,2, after grew to 3,7 ± 1,9 (р< 0,05). Cerebral oxygenation increased by 10% during inhalation. Tissue perfusion index rose (р< 0,05) (before 1,5 ± 0,5; during 3,2 ± 1,3; after 2,2 ± 1,0). After 2 - 3 sessions all children’s felt better, slept well without nightmares. Pain relieved after 5-12 sessions.

Conclusion

Xe inhalation improved pain management and stress treatment in pediatric patients in acute period of polytrauma.