A Practical Manual of Pediatric Cardiac Intensive Care

SECTION 1
GENERAL CONSIDERATIONS
1. Preoperative Stabilization and Transportation Guidelines
in Infants with Heart Disease .....................................................................3
Mahesh Kappanayil
� Rationale for Ensuring Safe Transportation 3
� Goals of Safe Transportation and Preoperative Stabilization 4
� Step-wise Approach 4
� Optimize Clinical Condition in Accordance with Underlying Physiology 5
� Arranging Transfer to Tertiary Care Hospital 6
� The Process of Transport 7 � Post Transport 7
2. Transfer of Patients from Operating Room to Pediatric Cardiac
Intensive Care Unit after Congenital Heart Surgery ...........................................9
Rakhi Balachandran, Aveek Jayant
� Sequence of Various Events Involved in the Transfer 9
3. Invasive Arterial Blood Pressure Monitoring and Care of Arterial Lines ................. 18
Rakhi Balachandran, Amitabh C Sen
� Goals of Invasive Arterial Blood Pressure Monitoring 18 � Choice of Site 18
� Articles for Arterial Line Insertion 19 � Arterial Pressure Monitoring Setup 19
� Insertion Care 20 � Maintenance of Arterial Lines: Nursing Considerations 20
� Change of Dressing and Insertion Site Care 21
� Procedure for Arterial Blood Gas Sampling 22
� Troubleshooting 22 � Complications: Detection and Management 23
� Removal of Arterial Line 24
4. Central Venous Catheters in Pediatric Cardiac Patients .................................... 25
Rakhi Balachandran
� Definition and Site of Cannulation 25 � Articles Required for CVC Cannulation 26
� Catheter Characteristics 26 � Preinsertion Procedure 26
� Insertion Care 27 � CVC Monitoring System and Transducer Setup 28
� Normal CVP Waveform 28 � CVC Complications 28
� CVC Insertion Site Care and Dressing Policy 30 � CVC Dressing Change 30
� CVC Monitoring and Maintenance 31 � Removal of Central Line in the ICU 33
CONTENTS
xiv Contents
5. Transthoracic Intracardiac Lines in Pediatric
Cardiac Surgical Patients........................................................................ 35
Rakhi Balachandran, Brijesh P Kottayil
� Types of Transthoracic Intracardiac Lines 35
� General Nursing Guidelines for Intracardiac Transthoracic Lines 38
� Guidelines for Removal of Transthoracic Lines 39
� Complications of Transthoracic Lines 40
6. Fluid and Electrolyte Management in Pediatric Cardiac
Intensive Care Unit ............................................................................... 43
Rakhi Balachandran
� Physiological Considerations 43 � Specific Challenges in
Pediatric Cardiac Patients 44 � Goals of Postoperative Fluid Therapy 45
� Postoperative Fluid Requirements 45
� How to Monitor Fluid Status and Intravascular Volume? 49
� How to Manage Fluid Overload? 51 � Electrolyte Management 52
7. Blood Glucose Management after Pediatric Cardiac Surgery .............................. 57
Rakhi Balachandran
� Summary of Evidence for Blood Glucose Management in Pediatric Intensive
Care Population 57 � A Suggested Blood Glucose Management Strategy 59
8. Pain and Sedation Management in Pediatric Cardiac
Intensive Care Unit ............................................................................... 64
Rakhi Balachandran
� Benefits of Analgesia and Sedation after Pediatric Cardiac Surgery 64
� General Principles of Pain Management 65
� Assessment of Pain 65 � Modes of Pain Management 65
� Nursing Considerations in Pain Management 74
9. Conventional Mechanical Ventilation in Pediatric Cardiac
Intensive Care Unit ............................................................................... 76
Rakhi Balachandran, Aveek Jayant
� Anatomical and Physiological Considerations in Pediatric Patients 76
� Cardiopulmonary Interactions 77
� Special Challenges while Instituting Mechanical Ventilation in Pediatric
Cardiac Patients 79 � Equipment Required for Mechanical Ventilation in PCICU 79
� Setting Up the Ventilator 80 � Common Indications for Mechanical
Ventilation in the Pediatric Cardiac Intensive Care Unit 84
� Goals of Nursing Care for a Ventilated Child 84
� Ventilatory Strategies in Special Situations 88
� Weaning from Mechanical Ventilation 90 � Managing Extubation Failure 92