University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
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Last updated June 9, 2014 10:10 AM

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University Hospital of Wales Heath Park
Cardiff
CF14 4XW
02920 747747

Transfer Guidelines

This section is written by the All Wales Paediatric Critical care Network. If you have any feedback to offer, use the contact link above, and it will be passed on to the group.

Most critically ill children (Levels 2 or 3) are currently moved between hospitals by the Paediatric Intensive Care Retrieval Team. However there are some patient subgroups that will continue to be transferred by the referring hospital:

Critically ill children are at increased risk of morbidity and mortality when being transferred. The decision to move or transfer any child must be made by the consultant responsible for the child's care in full liaison with the appropriate staff at the child’s intended destination and the child's family.

The transfer must embody clear, clinical advantages for the child and be balanced against the potential risks inherent during any transfer.

Children require not only resuscitation but comprehensive stabilisation prior to their transfer whether this is to scan (intra hospital) or to another trust (inter hospital). The centre that you are planning to move the child to should be informed as early as possible and advice sort.

Click on the panels below for specific advice - clik the panel header again to close it.

Safety

Safety must be paramount once the decision is made to transfer a child

  • The staff accompanying the child should have the necessary skills to maintain stability and treat any changes in the child's condition during its transportation.
  • They must be familiar with the equipment they are expected to use.
  • The child must be secure for the duration of the journey harnessed or seat belted onto the trolley. No children should be transferred sitting with/on parents. Car seats should not be used in ambulances to transfer critically ill children and should never be attached to the Ferno trolley or equivalent for transfer.

All parents and staff must wear a seatbelt for the duration of the journey.

  • The use of blue lights should be discussed by the team and only used if absolutely necessary as the use of them can increase the risk to the entire team and patient.

 

Mode of Transport

The local team are responsible for deciding what transport is deemed necessary for transfer of each case. Teams must be made aware of the implications if team members are not covered by adequate insurance. Air transport should only be used in exceptional circumstances.

Equipment
  • Neck Collar (in Trauma cases)

Airway & Breathing

  • Oropharyngeal Airway
  • Clear Laerdal mask
  • Self Inflating bag with oxygen reservoir
  • Ayres T-piece (desirable but should not be the only means of ventilation)
  • Oxygen supply (Flow (l/min) x 60 x journey time in hours x 2 or Minute volume x 60 x journey time in hrs x2)
  • Portable suction with Yankeur
  • Suction catheters (appropriate size for ET tube)
  • ET tube + size smaller
  • Laryngoscope (check battery + bulb)
  • K.Y Jelly
  • Elastoplast
  • Stethoscope
  • EtCO2 monitoring line
  • Portable ventilator (Babypaq if <10kgs) Alarms set
  • Paediatric Filter (no or minimal catheter mount)
  • Stylets / Bougies

Monitoring (adequate battery life)

  • ECG electrodes
  • Blood pressure cuff
  • Invasive monitoring may be desirable but transfer should not be delayed to achieve this.
  • Oxygen Saturation probe
  • Temperature
  • End tidal carbon dioxide monitoring
  • Syringe Pumps (adequate battery life)
  • Pen torch
  • Gamgee
  • Space Blanket
Drugs

Anaesthetic drugs are decided upon by the anaesthetist transferring the child
Drugs required for each transfer will depend on the clinical condition of the child.
This is a list of recommended drugs that should be considered prior to departure with any critically ill child.
A drug calculator can be found here to assist you in checking paediatric drug dosages.

Adrenaline 1in 10 000
Atropine 1mg in 5mls
Calcium Chloride10% in 10mls
Diazepam rectal tubes 5mg
Lorazepam 4mg in 1ml
Glucose 10%
Naloxone 400mcg in 1ml
Sodium Bicarbonate 8.4 %( 1mmol in 1ml)

Mannitol may need to be considered in neurosurgical emergencies.
Further anticonvulsants may be required if you have already administered Lorazepam.
Ensure that you have enough infusion fluids for the duration of your journey.

Pre-departure Check List

 

 

 

 

Airway replacement kit to hand

 

 

NG/OG Tube in situ

 

 

Notes Photocopied (scans packed if appropriate)

 

 

Is paperwork completed?

 

 

Baseline obs. Documented
(Including pupils)

 

 

Patient/Equipment secured
Harness in place.

 

 

Airway secured

 

 

Alarms activated

 

 

ET tube patent(suction before leaving if required)

 

 

Parents updated/contact number

 

 

ABG Checked on Transport Vent

 

 

Information booklet given

 

 

Adequate sedation & paralysis

 

 

Referral centre telephoned

 

 

Chest X-Ray checked

 

 

Rucksacks x 2

 

 

BM Stix checked

 

 

Drug Bag x 1

 

 

IV Access x 2 secure and patent

 

Istat
Pumps x 6
Chargers
Suction + correct size catheters