Parent Satisfaction With Pediatric Nurse Practitioner Care in Specialty Services.

INTRODUCTION: This study examined parent satisfaction with care provided to their children by Pediatric Nurse Practitioners (PNPs) in specialty areas at a tertiary care pediatric hospital. METHOD: A convenience sample of parents of children cared for by 19 PNPs in different specialty settings completed a confidential survey consisting of demographic information and the Parents' Perception of Satisfaction with Care from the Pediatric Nurse Practitioners Instrument (PPSC-PNP). Data were analyzed using SPSS (IBM, Armonk, NY). RESULTS: The overall PPSC-PNP mean score was 129.82/140. Mean subscale scores ranged from 27.15 to 28.51/30. The general satisfaction score showed a mean score of 18.31/20. No statistical difference was found in parental satisfaction when scores were analyzed by the child's age, parent participant, or patient setting. DISCUSSION: These findings indicate that parents are highly satisfied with the care their children receive from PNPs across various subspecialties regardless of the child's age and clinical setting.

Maintaining patency with packed red blood cell infusions: comparison of IV normal saline infusion vs. normal saline syringe method.

As blood products are being used more judiciously, registered nurses need to develop practices to facilitate the effective administration of these products. The study results suggest both the syringe push method and the continuous infusion method of normal saline provide adequate line patency during packed red blood cell infusions through peripheral catheters.

Digital Technology Distraction for Acute Pain in Children: A Meta-analysis.

CONTEXT: Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE: To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES: Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION: Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION: Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS: There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS: Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS: Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.

Preparing parents to help support their child post-amputation for bone cancer.

Amputation for paediatric bone cancer is cosmetically and emotionally disturbing. At the Stollery Children's Hospital, in Edmonton, Alberta, families are taken to see their child following amputation but before their child's anaesthetic has been reversed. Through a retrospective study we found that families found this step to be valuable in helping them prepare to support and care for their child post-amputation.

The natural history of vincristine-induced laryngeal paralysis in children.

OBJECTIVE: To outline the natural history of vincristine-induced laryngeal paralysis (VLP) in children. DESIGN: Retrospective case series and review of reported cases in the English-language literature. SETTING: Tertiary pediatric center. PATIENTS: The study included all children with a confirmed diagnosis of VLP by inspection and with complete clinical information. The sources for patient identification were a prospectively kept database and a review of the English-language literature, conducted on PubMed since 1966, as well as a bibliography search. MAIN OUTCOME MEASURES: Charts and literature were reviewed for demographics, primary diagnosis, other diagnoses, and duration and method of treatment. The prevalence of VLP, locally, was also calculated. RESULTS: Four children (3 boys and 1 girl) were identified in our database over a 5(1/2)-year period, and 10 children (1 girl, 8 boys, and 1 with sex omitted) were described in the English-language literature. Four children had unilateral vocal fold paralysis only, all left-sided. The median age was 2.6 years. Acute lymphoblastic leukemia was the underlying diagnosis in 8 patients. Two patients had Down syndrome, and 1 patient had Charcot-Marie-Tooth disease, type 1. Only 2 patients required tracheotomies, and 1 patient was treated temporarily with bilevel positive-pressure ventilation. The median duration of paralysis was 6.8 weeks. The prevalence of VLP was 1.36%. CONCLUSIONS: The data suggest that VLP is probably underreported and possibly underdiagnosed. Endoscopic inspection is a must in all patients with airway symptoms who are receiving vincristine therapy. Early recognition of VLP is mandatory, as it is reversible, has a good prognosis, and usually needs only interruption of vincristine therapy and conservative treatment.

Threshold current of an insulated needle in the intrathecal space in pediatric patients.

A threshold current of <1 mA has been suggested to be sufficient to produce a motor response to electrical stimulation in the intrathecal space. We designed this study to determine the threshold current needed to elicit motor activity for an insulated needle in the intrathecal space. Twenty pediatric patients aged 7.3 +/- 3.9 yr scheduled for lumbar puncture were recruited. After sedation with propofol, patients were turned to the lateral position and an 18-gauge or 20-gauge introducer needle was placed at the L4-5 level through which an insulated 24-gauge Pajunck unipolar needle (with a Sprotte tip and stylet) was inserted. The needle was advanced into the intrathecal space as suggested by the presence of a "pop." At this point, a nerve stimulator was attached to the insulated needle and the current was gradually increased until motor activity was evident. The needle hub was checked for cerebrospinal fluid. If cerebrospinal fluid was not present, the needle was advanced further until cerebrospinal fluid was present. The threshold current was retested. The mean current in the intrathecal space required to elicit a motor response was 0.6 +/- 0.3 mA (range, 0.1-1 mA). In 19 patients, the twitches were observed at the L4-5 myotomes and 1 patient had twitches at L2. Twitches were observed unilaterally in 19 children and bilaterally in one child. This confirms the hypothesis that the threshold current in the intrathecal space is <1 mA and that it differs significantly from the threshold currents reported for electrical stimulation in the epidural space.

Can continuous low current electrical stimulation distinguish insulated needle position in the epidural and intrathecal spaces in pediatric patients?

BACKGROUND: Muscle twitches elicited with electrical stimulation (6-17 mA) during epidural insertion indicate correct epidural needle placement while muscle twitches at a lower current (<1 mA) may indicate intrathecal needle placement. This study examined whether applying continuous electrical stimulation at 6 mA could indicate needle entry into the epidural space without inadvertently penetrating the intrathecal space. METHODS: After institutional review board (IRB) approval, 10 pediatric patients scheduled for lumbar puncture were studied. Following sedation with propofol, an insulated 24-gauge Pajunck unipolar needle was inserted through an 18-gauge introducer needle placed at the L4-5 interspace. The needle was first connected to a nerve stimulator (6 mA) and advanced. At the first sign of muscle twitching, needle advancement was stopped and the threshold current for motor activity was determined. The current was then turned off, the stylet was removed and the needle checked for cerebrospinal fluid (CSF). If CSF was not present, the needle was advanced into the intrathecal space (as confirmed by the presence of CSF). Ten pediatric patients (ASA II or III) aged 7.8 +/- 4.3 years (2.8-16.0 years) were studied. RESULTS: All patients had two distinguishable threshold currents as the needle advanced. The mean threshold current to elicit muscle twitch in the presumed epidural space was 3.84 +/- 0.99 mA. CSF was not present in any of the patients at this location. The mean threshold current in the intrathecal space was 0.77 +/- 0.32 mA. The average estimated distance from the first threshold location to the intrathecal space was 3 mm. All muscle twitches were at the L3-5 myotomes. Nine muscle twitches were unilateral and one was bilateral. CONCLUSIONS: Monitoring with an insulated needle with electrical stimulation at 6 mA may prevent unintentional placement of epidural needles into the intrathecal space.