It’s just another day for veteran nurse Cheryl Stanley as she prepares a very anxious 5 year old for sedation.
Stanley, clinical coordinator for sedation services at Akron Children’s Beeghly campus, greets Waymond with a warm smile and reassuring words.
After chatting with his mom, Stanley finds some common ground – Waymond attends the same school she did as a child.
MRI is commonly used as a diagnostic test. It provides clear images of parts of the brain that can’t be seen as well with X-ray, CT scan or ultrasound.
MRI is particularly valuable for diagnosing problems with the pituitary gland and brain stem.
If his testing rules out medical anomalies, Waymond’s doctor may prescribe medication to slow down his precocious puberty.
Due to a negative experience with a needle stick, Waymond is visibly distraught at the idea of getting an IV.
“I’m not going to do anything without telling you first,” Stanley says.
After taking his vitals and getting him settled on the bed, she hands him some circular patches to hold while she starts examining his arms.
It becomes clear upon examination why Waymond may have had a bad experience in the past.
“His veins are very hard to find,” Stanley says.
Once she identifies a few prospects, she asks him to help her stick the numbing patches in place.
“We need to leave those on for at least 20 minutes,” she says. “They will make your arm feel warm.”
While Waymond is distracted by cartoons on TV, Stanley finds another spot to draw his medication. Her reason is two-fold.
“Joint Commission requires us to find a quiet place so we aren’t distracted while drawing medications,” said Stanley. “Plus, I wanted to do it out of his view since he’s already so anxious about needles.”
Stanley and her team do sedations 5 days a month, taking up to 6 patients per day. Three times a month they also do Botox treatments on patients with cerebral palsy, and similar musculoskeletal conditions, to help reduce muscle tightness and spasticity.
Varying levels of sedation are available based on a child’s age, the procedure being done, and whether underlying conditions exist that make it hard for the child to lie completely still.
In addition to MRI, sedation is also commonly used in CT scans, bone marrow aspirations and lumbar punctures.
“I prefer to give less to start out because you can always give more if needed,” Dr. Khankan said. “But, if you give more to begin with, you can’t take it back.”
After some tears, and lots of reassuring hugs from his mom, Waymond’s IV is in place and he’s excited to pick a toy dinosaur out of the department’s treasure box.
“You’re doing a great job,” Stanley says. “You are very brave.”
Stanley and another nurse walk Waymond to MRI.
Once he’s on the table they show him how to turn the knob to adjust the table height while they connect the leads for the heart monitor, blood pressure and pulse oximetry machines.
When it’s time to hook up the sedation medicine line to his IV, Waymond becomes anxious again.
“No more needles!” he says.
“This isn’t a needle,” Stanley explains. “It’s like a Lego that snaps into place with another Lego. It doesn’t hurt at all.”
In less than 3 minutes Waymond starts to fall asleep and the nurses strap him into place and secure a plastic coil around his head.
Today’s MRI includes contrast, a solution that will be injected into Waymond’s IV, to highlight certain areas of his brain – making it easier for his doctors to detect lesions and abnormalities.
Stanley gets her some earplugs to muffle the noise the machine makes during the test, and a blanket to keep her warm in the chilly room.
Stanley closes the door and joins Dr. Khankan in the viewing and monitoring room where they keep tabs on Waymond’s heart rate, blood pressure, oxygen saturation level and ETCO2 during the test.
Stanley charts Waymond’s vitals into Epic, our electronic medical record system, every 5 minutes. After 17 minutes it’s time to administer the contrast.
“The contrast allows us to take higher resolution images,” Stanley says.
Waymond remains on the MRI table and is wheeled back to the pre-procedure area. He starts to wake up within minutes as the nurses transfer him into bed.
“All done?” he asks while still groggy.
“You are all done buddy,” Stanley says. “You did great.”
Fifteen minutes later Waymond is dressed and Stanley and his mom are reviewing his discharge summary.
“I will call you tomorrow to see how things are going,” Stanley says.
Stanley wheels them out to the exit and wishes them a good day.
“I enjoy being able to help kids get the tests they need so the doctors can figure out what’s wrong with them and treat their conditions,” she says.