Tuesday, November 13, 2012

Lumbar Puncture

Getting the opportunity to do procedures in my PICU can be few and far between sometimes.  Yes, we have a very busy 40 bed unit.  Yes, we have very high acuity much of the time.

But given that I'm one person, assigned to 6 kids (sometimes more, sometimes less) and don't work 24/7, things like doing central lines, intubations, and LPs just don't come along all the time.

Until this week!  I got to do my first lumbar puncture (or "LP" for my non-medical friends and family).

I got so lucky, because the Neuro Critical Care APN decided to save it for me.  It wasn't my patient.  But she knew that I was coming in, and she knew that I needed procedures.

Schooling to become an APN is great for some aspects, but certainly not great in getting in procedures.  So this was the lovely that I got to practice an LP on:
                                                                          [via]
Nice, right? And oh so lifelike!  Especially because the manequin that I was working on failed to actually have vertebrae..not that those are important for anything other than being the very cornerstone of placing the needle!

But I digress...enough with how school did not properly teach me how to do an LP, and back to the PICU that will!

The patient was 3 years old, super cute, and was easily bribed with chocolate pudding and mac-n-cheese (girl after my own heart!).  Until her parents left the room and she saw us putting on our sterile gowns and such.  Then it was all out freak-out, and really I can't blame her.  Although she had no idea what was going to happen, strangers wearing the get-up cannot be good in the mind of a 3 year old!

So after a ridiculous amount of sedation medications, the oh-so-still-slightly squirmy toddler was still enough for me to try.

I got my landmarks.  I numbed up the area.  And then I put in the needle. While it took a bit of repositioning, there has never been a more glorious site of fluid flowing out of a needle before!

And I must say that the Neuro Critical Care APN teaching me could not have been a better teacher.  She was so calm, so patient, and just so helpful.

The 3 doctors and 2 nurses watching me (not participating) could have left the room on the other hand! At one point, one of the doctors that I work with said "We are cheering for you! Just think of us as your cheerleaders!"

But really, who wants a bunch of cheerleaders in scrubs watching you as you put a needle into the spine of a squirmy toddler.  OK maybe someone who is attention seeking.  But that's not me.

So despite having an entourage of unwelcomed cheerleaders, I will welcome the chance to do LPs in the future!  I know that kids are a hard audience (gee, a stranger is coming at me with a big needle and going to put that WHERE!?)...but the more chances I'm getting to do procedures, the more and more I'm loving my job.

So bring on the procedures...just leave your cheerleading bloomers at home. Because this PICU APN wants nothing to do with that!




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