Preparing an Infant or Child for Emergency Transfer to the Paediatric Intensive Care Unit

• Aims
• Background and indications
• Procedure method

Aims

To standardise and optimise the stabilisation and transfer of critically ill infants and children to the Paediatric Intensive Care Unit (PICU) from other clinical areas within Leeds General Infirmary including the Leeds Children’s Hospital.

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Background and indications

Transferring any critically ill infant or child is challenging. Transfer carries additional risk to the patient whether performed between hospitals or within the same hospital.
For transfer to occur safely this procedure should be used when transferring any critically ill infant or child from another area in the hospital (such as the emergency department, general or specialty paediatric ward) to the PICU.

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Procedure method

1. Documentation and communication
   • PICU consultant has accepted patient for admission to PICU
   • PICU nurse in charge has confirmed bed available
   • Referring consultant has spoken to PICU consultant (on phone or in person)
   • Parents updated on child’s condition and need for transfer
   • Copies or originals of all relevant notes, investigations and drug charts
   • Highlight / document any social concerns
   • Highlight / document any infection control issues (including COVID status and need for PPE)
2. Patient preparation

   Endotracheal tube (ETT) secured (preferably Melbourne strapping) Consider confirming ETT position on CXR (ideally at T2) if patient Recent blood gas with blood sugar is intubated Gastric tube in situ Cardiovascular status improving or stable Minimum 2 points of IV access ideal but not essential Maintenance fluids for infants or following treatment of hypoglycaemia AVPU and pupils monitored and recorded Adequate sedation, analgesia and muscle relaxation for intubated patients Consider whether CT scan needed before admission to PICU At least one patient identification label in place Take steps to ensure patient temperature control and dignity / privacy

3. Equipment
   • Minimum monitoring for intubated patient - etCO2, SpO2, ECG, BP
   • Ambu-bag
   • Portable suction, Yankauer catheter and suction catheters
   • Consider whether portable ventilator or hand bag with Ayer’s T-piece
   • Adequate oxygen supplies (at least one full E cylinder or two CD cylinders)
   • Airway equipment (facemask, Guedel, laryngoscope, spare ET tubes +/- introducer)
   • Emergency drugs
   • ED paediatric transfer bag or PICU transfer bag
4. Personnel and role allocation
   • Recommended using porter (will help move equipment, radio for communications if problem en route, and will return equipment after transfer)
   • Minimum of one adequately skilled nurse/ODP and one doctor/ANP to accompany patient on transfer
   • Ensure clear role allocation including team leader
   • Consider pre-brief if risk of deterioration en route
5. On arrival to PICU
   • Stabilise on PICU ventilator (if intubated)
   • Transfer any infusions over to bedspace
   • Structured team handover (eg. SBAR) at bedspace to receiving PICU doctor and nurse - whole team should remain until information handover is completed
   • Update PICU consultant of any change in condition
6. Following transfer
   • All kit checked, restocked and returned
   • Offer “Time Out” / debrief to team members if needed