Healthcare and Medicine Reference
Specials: Paediatric Procedures
Kate McCann 1 and Amy Walker 2
1 New Cross Hospital, Wolverhampton, UK
2 Department of Neonatology, Birmingham Women's Hospital, Birmingham, UK
Box 22.1 Preparing for paediatric procedures
By the end of this chapter you should be able to:
understand the principles of performing practical procedures on
Find an appropriate room.
Decide on the tests required.
adequately prepare yourself, the environment, your equipment
Prepare appropriate equipment.
Enlist holder and distracter.
and the child for a procedure
understand the indications and contraindications for various
Wear protective gloves.
Position yourself comfortably.
describe how to perform a heel prick, take bloods, insert a
Limit attempts to two or three.
Have dressings, tape and sharps box within reach.
cannula, perform a lumbar puncture, and perform a suprapubic
urine aspiration on paediatric patients.
tape to stand the fi lled bottles in, have prefl ushed tubing ready to
connect to cannulae and adhesive dressings available to secure the
line. Children will not stay still while you search for materials.
Holding the child securely and providing effective distraction
will hugely improve the success of the procedure. Play therapists
are specialised in distraction, but a family member or colleague can
provide the required diversion. You may consider using dummies
or sucrose (depending on local policy) to calm babies. Up until
around 4 months, place babies in a cot or on a couch, with a
colleague stabilising the limb. After this age, their strength requires
a fi rm embrace (usually from a parent) along with limb stabilisa-
tion (see Figure 22.1). Older children may prefer to lie down, so
always ask their preference.
Senior supervision is required for all procedures until you are
competent to perform them alone. Limit your attempts to two
or three for the benefi t of both the child and the colleague who
follows. When the task is over, ensure that cannulas are well secured
with bandages and splints and allow parents to comfort the child.
It may be a cliché, but children are really not 'just small adults'.
Several of the interventions described here are similar to the adult
version, yet the approach requires more preparation. Though junior
doctors may be profi cient with adult procedures, children present a
greater challenge and it is important not to become disheartened if
it is initially a struggle. This chapter aims to provide useful tips and
advice for completing common paediatric procedures.
Preparation is the key to paediatric procedures (Box 22.1). Expect
wriggling, screaming and both the child and parents becoming
distressed. Verbal consent from parents must be gained for all
procedures and should be documented.
Firstly, plan a suitable location. A simple heel prick can occur at
the bedside, but more invasive tests should occur in neutral terri-
tory. Most wards will have a treatment room, since it is important
for the child to consider their ward bed as a place of safety.
In advance, choose what equipment is needed and which tests are
required. Infl icting pain in children should be minimised and blood
tests anticipated, so that sampling is not unnecessarily repeated.
Children's veins collapse at lower pressures so therefore we use grav-
ity and venous pressure to collect blood. This requires preopening
the bottles so that the blood can be dripped into them. Use a roll of
Local anaesthetic creams
These are widely used in paediatrics. Unless the child is seriously
unwell, apply anaesthetic cream before a painful procedure. Consult
local hospital policy regarding age criteria for use.
Cannulation, venepuncture and lumbar puncture.
Previous adverse reaction, broken skin and severe eczema.
EMLA® not recommended in neonates.