Children’s National Medical

Center
Cindy Thrasher, RN, CPN
RN III
Division of Diagnostic Imaging
& Radiology

Objectives
1. Evaluate current and emerging trends in three different
pediatric care delivery settings.
2. Analyze clinical practice through use of evidence based
concepts into the assessment, management, and communication
of nursing care provided to medically complex pediatric
patients.
3. Relate early signs of clinical deterioration and intervene with
clinical expertise to prevent or reduce the risk of
complications.
4. Examine health systems and care processes to accelerate
treatment time to prepare, communicate and rescue complex
pediatric patients.

1
Practice in motion

I’m going to
see the Boss
this
weekend
for the 300th
time!!!!!!!

2
 Case # 1

ƒ Request for PICC line placement

ƒ 2 week old full term infant with h/o
hydrocephalus and s/p VP shunt placement
ƒ Infant now presents with 5 day h/o wound
breakdown and leaking clear fluid
ƒ As per PMD, parent to apply hydrocortisone
ointment and antibiotic cream to incision line

SBAR Report Rec’d

S: 2 week old infant VP shunt infection, NPO for
sedation.

B: Admitted for long term ABX treatment

an externalization of VP shunt

A: No acute distress, VS WNL

R: Order to sedate with chloral hydrate 50mg/kg by

mouth for PICC line placement

3
 Nursing Assessment

Patient On Arrival to Interventional

Radiology

• Infant on CR monitor
• AF depressed
• Somnolent, & Non interactive

Physician Order’s
Less than 6 months: Chloral
Hydrate ____mg ( Maxdose:
50 mg/kg/dose)
Greater than 6 months:
Chloral Hydrate ____mg (Max
dose: 75 mg/kg/dose)
(Max adult dose 1 gram/dose
or 2gram/24 hours) P.
Chloral hydrate _____mg (25
mg/kg/dose) PO PRN 20
minutes after dose if sedation
not achieved.

4
 Nursing Care Provided

Evidence Based Practice

Withheld Sedative- Hypnotic Drug

Used Instead:
Sweeties – Sucrose Water packaged
ELMAX – topical application of anesthetic
Music Mobile – Attached to Crib from
Home

5
 Case # 2

Request for MRI

18 year Obese female with Downs
syndrome, developmentally delayed,
H/O pneumonia, FUO, abdominal pain,
NPO for several hours, ASA airway
classification III, non cooperative patient
and very upset parent due to late
afternoon appointment and repeated
procedure delays

SBAR
S: request for abdominal MRI to determine etiology of abdominal
pain
B: Downs syndrome
congenital cardiac defect, enlarged tonsils, fearful of environment
and mask induction sedation
A: Arrived to MRI anxious, somewhat combative, developing
respiratory distress as agitation increased, and based on
appearance looked likely to have risks for airway compromise
(short neck in flexed position)
R: Sedate patient, plan to reduce stimulation, create non threatening
environment in partnership the mother. Implement alternative
approach to basic mask induction.

6
 Anesthesia Bay

Music: Is the Universal Language

7
 Evidence Based Practice
• Implemented Distraction Techniques
Adjunctive Procedural Support Music Therapy in the
Healthcare setting

• Used family presence and participation in child’s care

to reduce anxiety and provide developmentally
delayed child with coping strategy

• Use of SEVO GAS in the induction phase of sedation

administered by the Anesthesiologist -

Dr. Becker

8
NIKKI & LANCE

Solar Sedation

9
 References

Chloral Hydrate- General Monograph Sedative-Hypnotic., Rx Med: Pharmaceutical

Information 2009
Cortellazzi P., Lamperti M., Minati L., Falcone C., Pantaleoni C., Caldiroli D.,
Sedation of Neurologically Impaired Children Undergoing MRI : a Sequential
Approach. Paediatric Anesthesia. 2007 Jul; 17(7) :630-6
Kain ZN., Caldwell-Andrews AA., Krivutza D.M., Interactive Music Therapy as a
Treatment for Pre-Operative Anxiety in Children: A Randomized Controlled
Trial. Anesthesia Analogs 2004, 98:1260-1266
Lefrak, L. Burch K. Caravantes R. et al Sucrose Analgesia: Identifying Potentially
Better Practices. Pediatrics 2006;118;S197-S202
Walworth D.D., Procedural Support Music Therapy in the Health Care Setting: A
Cost Effective Analysis. Journal of Pediatric Nursing. Vol. No. 4 (Aug. 2005)

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