A pediatric care and resuscitation cart: One community hospital's ED experience

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1 Melquist/JOURNAL OF EMERGENCY NURSING abuse. The Center promotes awareness of child sexual abuse by stocking parent education pamphlet racks in the pediatric unit and the ED lobby, presenting sexual abuse awareness programs to local teachers and social workers, and producing and distributing pamphlets to local physicians to promote the use of the Care Center. The team has also conducted a sexual abuse grand rounds and seminars on domestic violence, and the physicians have taught medical residents about the signs of sexual trauma in children. Donations from the hospital foundation and several local organizations were used to purchase equipment and parent education materials, and for staff development. This has been an exciting and busy few years for the Care Center staff. Much work still needs to be done, but the group is proud of its accomplishments. Children are being examined in a very "pro-child" environment, parents are being given much-needed information, important evidence is being collected and shared with the authorities, and the relationship between the Care Center and the county children's center has been strengthened. One of the major accomplishments has been the formation of a truly collaborative practice between the Care Center nurses and physicians. This has contributed to making the Care Center a productive and successful experience for all involved. A pediatric care and resuscitation cart: One community hospital's ED experience Author: Joan Elaine Begg, RN, CEN, Centerville, Massachusetts I n September 1993, the Cape Cod Hospital Emergency Center's staff moved into its brand-new 20,000 sq. ft. emergency center. Although the new emergency department was state of the art, the pediatric cart was antiquated. Many of the staff members were CEN certified with Pediatric Advanced Life Support (PALS) training, so the need to update the cart was evident. As the staff nurse in charge of stocking and ordering supplies, I worked with the clinical coordinator and clinical educator to purchase a cart that would provide adequate space for storage of the specific equipment and sizes needed, as well as ease of use in emergency situations. We have used the Broselow Tape* for many years as recommended by the PALS course and benefit from its easily understandable format. Initially we chose color-coded plastic bags to contain the different sized *Broselow Pediatric Emergency Tape is a trademark of Broselow Medical Technologies, Hickory, N.C. No endorsement of this product is implied. Ms. Begg is a staff nurse, Emergency Department, Cape Cod Hospital, Hyannis, Massachusetts. For reprints, write Joan Elaine Begg, RN, CEN, 112 Emerson Way, Centerville, MA J EMERG NURS 1995;21: Copyright by the Emergency Nurses Association /95 $ /9/68031 equipment. We liked the idea of having the specific sized equipment for each weight range readily packaged, but the plastic bags would not allow the different catheters to lie flat. After some time, and with frequent checking, many of the sterile packages became An attendee of the ENA Scientific Assemblies for many years, I had a chance to view many storage carts offered by different companies. ripped and sterility was not intact. It became apparent that a different arrangement was necessary. As an attendee of the ENA Scientific Assemblies for many years, I had a chance to view many storage carts offered by different companies. I wanted a cart that would provide goodqooking storage, ease of use in an emergency, plus adequate room to accommodate the many different size ranges as defined by the Broselow system. We ultimately purchased an upright rolling cart December

2 JOURNAL OF EMERGENCY NURSING/Begg Figure 1 Inside each of the top nine drawers is a removable plastic tray complete with a clear Lucite plastic cover. This allows the contents to remain dustffee at all times, while maintaining precise visibility of its contents. This makes "cart checking" much easier. with nine drawers from Armstrong (Armstrong Medical Industries Inc,, Lincolnshire, Ill.) The basic cart was accessorized with a three-tier trellis device outfitted with clear plastic tilt-out bins, plastic traydrawer liners with clear lids and a modular divider system, side shelf, attached IV pole, oxygen tank brackets, and cardiac board. The cart was both good looking and very functional because all items were either easily accessible from the labeled drawers or clearly visible in the clear plastic bins. The top eight drawers are 3 inches deep; the bottom drawer is 6 inches deep. The drawers can be secured with a cutaway banding system, making shift checks easier. The cart is kept secured until needed, when the band is cut away. When the cart is no longer in use, the supplies are replenished by the nursing personnel and the cart is then resecured. If the cart is found to be unbanded during shift checks (once every 24 hours by a specifically designated nurse), then the cart is totally checked for its contents. There is a platform space on top for storage as well as a trellis-type storage system that holds plastic bins for smaller items mounted on top of the platform. A rigid CPR board and attached IV pole complete the cart. Inside each of the top nine drawers is a removable plastic tray complete with clear plastic covers. These covers keep stored items dust free and visible. The fact that the drawers are readily removable makes cleaning much easier, but more importantly, in the event of two simultaneous pediatric emergencies, the appropriate tray can be removed from the cart and used in a different room. The first day our cart was in use this scenario happened. While the cart was in use for the first child, the red drawer was removed and taken to another room for the second child. The readily accessible equipment saved valuable time and reduced stress. Each tray is sectioned with plastic dividers that can be moved if the contents change in the future. The clear covers are labeled with the contents and specific sizes of the items that are directly under each label. This reduces time-consuming searches for needed items. The specific sizes are prominently displayed when the cart is restocked. See Table 1 for the contents and arrangement of the drawers in our storage cart. Pediatric bag-valve-mask devices hang from the attached IV pole. Intravenous infusion devices are readily available in the acute care areas and because of space limitations are not specifically attached to the pediatric cart. Other resuscitation equipment that may be needed, including specialized sterile suture trays, sterile pediatric tracheostomy kits, heart monitor/ defibrillator, and blood glucose monitoring equipment, is kept routinely in the acute care areas and therefore is not stored on the cart. The only other equipment we commonly use in infant and neonatal emergencies is an infant warming 556 Volume 21, Number 6

3 Begg/JOURNAL OF EMERGENCY NURSING Figure 2 We p u r c h a s e d an upright, rolling cart from the A r m s t r o n g Company, a n d c u s t o m i z e d it w i t h d r a w e r s t h a t w e r e color coordinated to the colors of the Broselow Tape. We a c c e s s o r i z e d the cart w i t h a side shelf, a three-tier trellis device outfitted w i t h clear Lucite tilt-out bins, a n d a n a t t a c h e d IV pole. Figure 3 One of t h e m o s t i m p o r t a n t features of the cart, is t h e removability of the individual drawer liners. This allows us, in t h e e v e n t of two simultaneous pediatric e m e r g e n c i e s, to move a specific drawer to another room a n d treat both p a t i e n t s in a timely a n d pediatric-specific manner. December

4 OURNAL OF EMERGENCY NURSING/Begg Table 1 Pediatric equipment cart contents Top row bins (left to right) Pediatric pulse oximeter cables (connector cable to our Hewlett-Packard monitor system) Nelleor Oxisensor transducers (3 sizes) 1-20 (Infant 1-20 kg) D-20 (Pediatric kg) N-25 (Neonatal/Adult <3 kg, >40 kg) Oxygen face masks Toddler and child sizes Urine collection devices Newborn and Pediatric sizes Child row bins Pediatric cardiac monitor electrodes Infant blood pressure cuffs, disposable style Infant (8-13 cm) Child (12-19 cm) Blood pressure cuffs for use with automatic blood pressure monitor Infant (8-13 cm) Child (12-19 cm) Baptismal water Bottom row bins Neonatal blood pressure cuffs for use with automatic blood pressure monitor Sizes #1, #2, #3, #4, #5 Pediatric nonrebreather oxygen masks Nasal cannulas Infant size Pediatric size Additional banding units and scissors Side shelf Automatic blood pressure monitoring device Reference books Top drawer (Beige) Broselow tape McGill forceps ( Respiratory syncytial virus culture swabs Blood glucose oxidase sticks (alternative please use glucometer) 10% dextrose feeding solution (x2 with nipples) Umbilical catheter tape Calculator Laryngescope handles Blades Size 0 straight (x2) Size 1 straight (x2) Size 2 straight (xl) Size 2 curved (xl) Bulbs (x2) (x2) Extra C batteries Catheter adapters Pacifiers 3 oz. blue bulb syringe Lancets Spinal needles, #22 1", #22 1~" (3 each) Ampicillin, 500 mg vial (x2) Gentamycin, 80 mg vial (x2) Heparin, 1000 mg vial (x5) Pediatric digoxin, 0.1 mg ampule (x3) Neonatal naloxone (Narcan), 0.02 mg/ml vial ( Pediatric digoxin, 0.1 mg ampule (x3) Sodium bicarbonate, 4.2% 2.5 meq (0.5 meq/ml) (x3) Pediatric atropine, 0.25 mg (0.05 mg/ml) (x2) 25% Dextrose, 2.5 gm (250 mg/ml) (x3) Red drawer (neonate [3-4 kg] and infant [4-8 kg]) Neonatal endotracheal tubes 2.0 ( 2.5 (x2) 3.0 (x2) Infant endotracheal tubes 3.0 (x2), 5F 8F Female catheter kit (xl) 8F Foley catheters (x2) Sizes 0, 00, 000 Knit caps Pink and blue Neonatal padded armboard 8F (x3) 5F-8F Feeding tubes 8F Infant gavage trays Lavender drawer (Small Child [ kg]) 4.5 ( 8F to 10F Foley catheters, (x2) each size Small child size 6 Knit caps Pink and blue 8F (x2) 8F Infant gavage set 10F Salem sump tubes (continued) 558 Volume 21, Number 6

5 Begg/JOURNAL OF EMERGENCY NURSING Table 1 (continued) Yellow drawer (Child [12-14 kg]) 4.5 (x2) Pediatric equipment cart contents 10F Foley catheter 8F Female catheterization kit 12F Foley catheter Child size 7 8F to 10F (x2 each) White drawer (Child [14-18 kg]) 4.5 (x2) 10F to 12F Foley catheter 8F Female catheterization kit Child size 7 10F to 12F, xl each Blue drawer (Child [18-23 kg]) 10F to 12F Foley cateters (x2 each) Child size 7 and small adult Nasogastric tube 12F to 14F (x2 each) Orange drawer (Child/SmaU Adult [24-32 kg]) 6.5 (x2) 12F Foley catheter (x2) Child size 7 and small adult Nasogastric tube 14F, 16F, 18F ( each) Green drawer (Large child/small adult [32-34 kg]) 6.5 (x2) 7.0 (x2) Urinary catheter 12F Foley catheter ( Medium adult 12F (x2) --18F Large Bottom Drawer Pediatric blood tubes/heel warmers Intraosseous needles T-Port connectors Assorted umbilical vessel catheters, 3.5F and 5F Bile bag for connecting nasogastric tubes to gravity drainage (wall suction too strong) Umbilical catheterization kit In-line IV burrettes Pediatric stethoscope Pediatric internal jugular IV insertion kit #12 and #20 Trochar kits Pediatric arm boards Butterfly needles, assorted sizes #22 and #24 Angiocatheter or Jelco IV catheters table, which provides for a lighted and warm treatment area for our smallest patients. The table is kept in the nursery and is readily available whenever we need to use it. We have found this pediatric cart system works well and has met all our needs to date. A movable cart allows us to handle a pediatric emergency in any of our six cardiac resuscitation rooms and easily bring the equipment to that area. Our hospital's recovery room staff is following our lead and is duplicating this cart for their pediatric emergency preparedness. December