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Are pediatric trauma carts missing essential supplies?
It’s the worst pediatric trauma case you’ve ever seen in your ED: A child has life-threatening injuries from a motor vehicle accident. You rush to gather supplies and notice that the appropriate-sized chest tube is missing.
Don’t let this unthinkable scenario occur in your ED. "If you are going to care for any pediatric patients, you need the right size equipment or you will have problems," warns Kaaren Fanta, RN, MSN, CPNP, trauma nurse practitioner at Cincinnati Children’s Hospital.
If the right equipment is not readily available, results can be devastating, says Pamela Smith, RN, BSN, clinical nurse leader for children’s emergency services at Medical University of South Carolina in Charleston. "Imagine trying to intubate an infant without an infant-sized tube or laryngoscope," she says.
Still, many EDs are lacking appropriate supplies for pediatric trauma patients, especially those that see these cases only rarely, says Smith. Even small community EDs must be ready to stabilize a child until transport arrives, which would necessitate having appropriately sized airway supplies and vascular access devices, she adds.
"They could get away with putting a needle in the chest for a pneumothorax if they don’t want to go to the expense of carrying the smaller chest tubes, or they could decrease the amount of sizes they carry," she says. "Obviously, this will not work for a hemothorax."
There is a tendency to believe that "pediatric trauma won’t happen in our ED," says Kelly Arashin, RN, ADN, CEN, charge nurse and trauma coordinator at Hilton Head (SC) Regional Medical Center. "Unfortunately, it does happen, and often it turns out that when it does, some EDs are not prepared," she warns.
Pediatric patients are not "little adults," says Arashin. "Children have anatomical features unique to their population, which pediatric supplies are designed for," she says. "Not having appropriate equipment or supplies can have disastrous consequences."
You can significantly improve care of pediatric trauma patients by following these tips:
For example, for a child weighing 10 kg, you would pull a packet containing all the appropriately sized equipment in one place, including face mask, Ambubag, endotracheal tube, and suction catheters, suggests Fanta.
"Keeping supplies stocked and replenished after each use will ensure the proper equipment is ready to use when needed," adds Arashin.
According to Fanta, your pediatric trauma cart should contain the following items in pediatric sizes: endotracheal tubes, face mask/resuscitation bags, laryngoscopes, oral airways, suction catheters (down to 6 FR) intravenous catheters (down to 24 gauge), interosseous needles, chest tubes, cervical spine collars, and blood pressure cuffs.
Supplies that are rarely used in EDs and therefore, might be overlooked include smaller sized chest tubes and central lines, says Smith. "We often use pediatric-sized triple lumens or pediatric jugular kits for central line access," she says. "The other thing missing would probably be intraosseous needles."
At an absolute minimum, EDs should have airway equipment and the ability to do vascular and/or intraos-seous cannulation, says Smith, adding that laryngeal mask airways can be used in infants. "Obviously, appropriate airway size equipment is the most important thing," says Fanta. "If you cannot manage the airway, the patient will deteriorate."
On the color-coded Broselow Pediatric Emergency Tape, the right-sized equipment is listed for each color, and this is a good rule of thumb to go by, says Smith. (For information on ordering the tape, see resources, below.) The tape lists the right size for endotracheal tubes, stylet, suction catheter, laryngoscope, bag valve mask, oral airway, laryngeal mask airways, urinary catheter, end-tidal carbon dioxide detectors, nasogastric tube, intravenous catheter, interosseous lines, chest tubes, and blood pressure cuffs.
"For those who do not do pediatrics frequently and are unsure of the correct size equipment to use, this is a great tool," she says.
You can use the tape as a reference whether you stock supplies in a cart or a bag, says Smith. "Whether you use a cart or a bag depends on the amount of storage room you have for a cart vs. a bag and how secure the unit can keep the bag," she adds.
There were problems with missing supplies due to physicians using the bag for teaching purposes, she explains. "We can lock each individual drawer of the cart and don’t have to restock the entire thing," says Smith.
The Broselow/Hinkle ColorCode Cart with fully stocked Broselow/Hinkle Pediatric Emergency System gives you a mobile work station with everything you need for a pediatric emergency, says Smith. However, if you can’t afford the cost of the this, which is approximately $2400, another option is to use colored plastic boxes with all of the appropriate size equipment in them for each color on the tape, suggests Smith. They can be stored in the bottom of the resuscitation cart so they are easily accessible, she says. "The carts are very expensive for a unit on a tight budget, and this is one alternative to actually purchasing the cart," she says.
For more information about pediatric trauma supplies, contact:
The Broselow Pediatric Emergency Tape’s 2002 Edition reflects the latest guidelines from the American Heart Association. A reference at each color bar on the tape informs you of equipment sizes to perform emergency resuscitation on a child. A reference at each weight zone on the tape shows pre-calculated medication dosages and infusion rates. The cost is $120 for a package of five tapes, plus shipping cost, which varies depending on location. To order, contact: