Intra-hospital Paediatric Transfer Guidelines.pdf - St-marys ...

St Mary’s Hospital Anaesthetic DepartmentIntra-hospital Paediatric Transfer GuidelinesThese guidelines should be followed by anaesthetists that areinvolved in the transfer of intubated/high dependency children fromtheatres, A+E, radiology and PICU.Post op transfers are the responsibility of the paediatricanaesthetist(s) involved and should be managed by him/her unlessspecial arrangements have been made.Pre-transferPatient should be resuscitated and as stable as possibleprior to transferInform family if relevant (N.B. family may accompany child ifappropriate)Appropriate personnel accompanying child- Minimum one doctor and one ODP/nurse competent inpaediatric airway skills and resuscitationEnsure adequate knowledge about patient or if different teaminvolved in transferring child undertake full handoverCalculate and prepare doses of drugs according to weight ofchild, including atropine and suxamethoniumCalculate dose of adrenaline required in the event ofresuscitationEnsure adequate oxygen and drugs in order to sedate andventilate independent of anaesthetic machines outsidetheatresContact the receiving departmentPre-transfer checklistIn the event of a cardio-respiratory arrest en route transfer to the nearestward immediately and put out a paediatric cardiac arrest call (ext 2222).Inform the consultant and family as soon as possible.Post-transferHand over to receiving team if appropriateDocumentation of transport, including observationsDocumentation of critical incidents (paper and electronic)

Intra-hospital Paediatric Transfer Checklist from Theatres,A+E, Radiology and PICUAirway + BreathingFacemaskOropharyngeal airwayETTs (same size + size below)Laryngoscope + bladeAyre’s T-Piece/ Adult circuitHMEPortable ventilator (optional)Full oxygen cylinder (minimum E size)Portable suction unitSedation (boluses or infusion)/ Intubation drugsParalysis (boluses or infusion)CirculationResuscitation drugs (suxamethonium, atropine, adrenaline minijet)Resuscitation box (paediatric/adult)Secure IV accessSaline flushesMonitoring – Philips paediatric transport monitorCharging leadSaO2 + probeETCO2- mainstream/sidestreamECGNIBP (auto mode 3-5min cycles/manual mode if IABP in use)IABPTemperatureAirway pressure gauge (necessary when hand ventilating)Paediatric Transfer PackNotes, anaesthetic chart, drug charts, X-raysLift key (if porter not present)

Paediatric Transfer BagAimsPolicyTo ensure that all staff understand the content andpacking of the equipment bagsTo provide continuity and familiarity between departments.The same bag design will be utilised by Theatres, PaediatricA+E and PICU.To provide rapid access to equipment required for theimmediate management of an anaesthetised or critically illchild.To reduce duplication and variability of equipment carried onthe bedThere are four Paediatric Transfer Packs in SMH at all timesonein the Paediatric theatre (main theatres), one in WEHtheatres, one in Paediatric A+E and one in PICU.The responsibility for re-stocking a used bag lies with thedoctor and ODP/nurse that used the bag.The bag should be checked and restocked by a two-personprocess of challenge and response:o Check all sections for intact toggles. If the main sectionhas a toggle intact there is no need to check inside.o Only those sections with missing or no toggles (ie frontpouch and inside pouches if main pouch breached) Resealwith toggles once re-stocked.Each month a full inspection of the bag takes place bynominated ODPs/ nursing staff.All sections of the bag must be checked using the contentslist. It is important to check the expiry dates of drugs andsterile equipment.Soiled bags must be cleaned.The contents of the bag are listed below.

Paediatric Transfer BagOutside PocketsBougies:1x 5F1x 10F1x 15F1x paediatric ambubag1x adult ambubag1x adrenaline minijet1x atropine minijet2x goggles1x stethescope1x small sterile gloves1x medium sterile gloves1x large sterile glovesRange of non-sterile latex-free gloves

Infusion Bag1x 14G venflon1x 16G venflon2x 18G venflons2x 20G venflons2x 22G venflons4x 24G neoflons2x 20G short abbocaths2x 22G abbocaths50ml leurlocksyringe3x 3-way taps2x 3-way taps with 10cm extensions10x capsAdultbloodgiving set1x 500ml 0.9% NaCl1x 500ml 0.9% NaCl3x 150-200cm extensions2x large tegaderm dressings2x small tegaderm dressings2x red steri-strips8x alcohol wipes1x spike1x spikeTransporetape roll

Intubation BagUncut endotracheal tubes:2.5 + stylet3.03.54.04.55.05.56.0 cuffed6.5 cuffed7.0 cuffed8.0 cuffed1x hygrobaby HME filter1x hygroboy HME filter1x angle piece1x catheter mount2x KY jelly packets2x tube ties1x 5ml syringe1x Miller 0 blade1x MacIntosh 3 blade1x elastoplast roll1x narrowlaryngoscopehandle + size 0Magill blade1x largelaryngoscopehandle + size 2MacIntosh bladeSuction catheters (2 of each):5, 6, 7, 8, 10, 12, 14 F1x paediatric yankeur sucker1x adult yankeur sucker1x small McGills forceps1x medium McGills forceps1x scissors1x LMA # 11x LMA # 1.51x LMA # 21x LMA # 2.51x LMA # 31x 000 Guedel airway1x 00 Guedel airway1x 0 Guedel airway1x 1 Guedel airway1x2 Guedel airway1x3 Guedel airway

Main Section1x burette giving set1x paed Hudson FM with reservoirbag1x adult Hudson FM with reservoirbag1x 00 FM1x 0/1 FM1x 2 FM1x 3 FM1x 4 FM1x 5 FM1x 5F NGT1x 8F NGT1x 10F NGT1x 14F NGT1x 20ml syringe1x 50ml bladder syringe1x bile bag1x pH indicatot strips1x Mapleson F breathing circuit(paed T piece)1x Mapleson C breathing circuit(adult)1x in-line nebuliser kit5x 10ml 0.9% NaCl5x 10ml H2O1x fluid giving setDrug labels:4x yellow additivestickers6x 0.9% NaCl4x plain white4x adrenaline4x noradrenaline4x dopamine4x suxamethonium4x atropine4x morphine4x midazolam2x lancets for capgases5x cannula dressings1x small splint1x large splint1x crepe bandage2x sterile gauze1x neonatal CO2adaptor1x paed CO2 adaptor6x adult ECG dots1x packet neonatalECG dots1x infant SaO2 sensor1x paed SaO2 sensor4x tempadots1x pen torch1x 500ml 10% dextroseSyringes:4x 1ml2x 2ml2x 5ml2x 10 ml2x 20ml1x 50ml1x 16G Cook IO needle1x 18G Cook IO needle1x 3-way tap with 10cmextensionNeedles- assortment ofall sizes

Adverse EventsEvent Details and OutcomeIncidentformcompletedPhysiologicalCVS Significant bradycardiaArrhythmiasSignificant hypotensionCardio-respiratory arrestOtherRS Major desaturationAspirationPneumothoraxRespiratory arrestOtherCNS Decrease in GCS/AVPULoss of pupillaryreflexesFittingOtherMisc. Hypothermia ( 34 C)Hypoglycaemia( 2.5mmol/l)EquipmentfailureDelaysOtherExhaustion of oxygensupplyBlocked ETTAccidental extubationEndobronchialintubationVentilator malfunctionLoss of I.V. accessMonitor malfunctionForgottenequipment/drugsDamage to equipmentAbsent/inadequatetransfer packOtherPatient/staff not readyPorter not availableLift delay/breakdownOther