We describe our experience of using High Flow Nasal Cannula (HFNC) Oxygen on the paediatric wards during a 4 year period from January 2014 to October 2017. A standard operating procedure (SOP) provided instructions and guidance for the use of HFNC. Retrospective analysis of demographic data,clinical conditions, indications, HFNC settings, adherence to SOP, adverse events and safety profile was undertaken over the 4 year period. HFNC was used in 124 babies and children, for a variety of conditions requiring respiratory assistance. Bronchiolitis was the commonest indication for the use of HFNC, followed by pneumonia, viral induced wheeze, asthma, and for alleviation of respiratory distress at the end of life in palliative care situations. Relatively high flow rates compared to other centres of upto 4 Litres/kg was used, with no adverse effects such as air leaks. Conversion to NIV modalities such as CPAP and BiPap and intubation rates was comparable to other centres. Our findings agreed with previous studies that HFNC failure rates could be predicted by the lack of repsonse of respiratory distress and oxygen requirement, 60–90 min after commenicng HFNC. Incremental expansion of the use of HFNC was seen over the study period as well as extension of its use to a variety of clinical conditions. This was achieved without additional medical resources, but by nursing empowerment through training for the safe initiation, weaning and cessation of HFNC, as well as timely escalation.Our experience of the use of HFNC is unique in using high flow rates in large numbers of children with a wide variety of respiratory conditions, in a non-paediatric intensive care setting.
hospital management for use in future inductions. We received excellent feedback and the areas we highlighted were used as a basis to frame induction requirements in subsequent redeployments. Conclusions Paediatric trainees have much to gain from the redeployment experience. As a trainee group we have sufficient medical training to revert to adult medicine and have the procedural, situational awareness and communication skills to thrive in unfamiliar settings. However, uncertainty can adversely impact well-being whilst preparedness allows trainees to both better cope and to excel in new environments. From our experience of redeployment we identified key areas of uncertainty and addressed them in a framework that can be translated to other trusts and for other specialities. We believe that providing structured information to trainees moving out of their comfort zone helps them to best support their adult colleagues, to take advantage of development opportunities and builds resilience.
13.9%) and toys/lego (32; 11.1%). Button batteries and magnets were ingested by 35 (12.2%). Liquids were ingested by 42 (13%), with the most common liquid ingested being liquitabs (8; 20%). Insertions accounted for 122 (44.4%) attendances, most commonly in a single nostril (72; 25.3%) or ear (39; 13.7%). Eight (3.7%) families were provided with advice on preventing recurrence of ingestion/insertion at discharge.The total number of aural/nasal insertions between 1st June-31st August 2020 was 59, compared to 65 in 2019. The insertion location and offending object were similar between years. Conclusions We demonstrated no change in frequency of aural/nasal insertions between 2019 and 2020, though comparison between years for ingestions was not possible. We have highlighted areas for improvement in communicating safety messages to families as part of a wider programme of discharge advice, and public health messaging. A significant minority had ingested very hazardous materials, and almost one-quarter required hospital admission or follow-up. These offer particular focus for strengthened messaging to reduce serious injury through prevention.
and 22% from secondary care. In 61% (25 out of 41) of these children there was symptom resolution with no further interventions, and they were discharged back to their GP. 34% of children (14 out of 41) had an alternative diagnosis like constipation, infectious diarrhoea, or toddler's diarrhoea. 1 patient in the group studied (3%) had a confirmed diagnosis of inflammatory bowel disease and they were already under specialist gastroenterology clinic. Of the group studied, the highest calprotectin level was 1660 (attributed to a campylobacter infection. Conclusions The majority of faecal calprotectin requests comes from primary care setting. The value of this test as a diagnostic marker for inflammatory bowel disease is poor. If it is elevated, alternative diagnosis like constipation and infection should be considered. We propose that faecal calprotectin in children less than 4 years of age should only be requested in secondary care. If elevated, the test should be repeated after 4 weeks and if persistently elevated, children should be referred to Paediatrician with expertise in Gastroenterology. We also propose that the laboratory reports for elevated faecal calprotectin level should state the above plan and not mention the possibility of inflammatory bowel disease, as is currently done. We believe that this will help streamline specialist referrals, reduce unnecessary investigations and more importantly reduce parental anxiety.
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