Pediatric

Procedures by: Bee Jane T. Martinez, MD, DPPS, FPCC

Body Measurements
— Length measurements
Neonates / infants: commercially available measuring device with a fixed
headboard and a movable footboard
Children>2 years old: non stretchable measuring tape permanently mounted to a
wall or door
— Weight measurements
Neonate /infants: Pan scale (manual with beam and non detachable weights or
electronics)
Children: Platform scale (manual with beam and non detachable weights or
electronics)
Head circumference

— Body proportions
Skeletal maturation:
Obtain x-ray of appropriate bony structures. Identify the growth centers of the
x-rayed bones and compare their development with standards established by
Greulich and Pyle or by Tanner & colleagues
Arm span

Upper to lower segment ratio: Measure the distance from the upper edge of the
symphysis pubis to the soles of the foot to determine the lower segment. Subtract
this measurement from the height measurement to obtain the upper segment
length. Calculate the US/LS ratio

— Pulse measurements: assessed by palpation or ausculation. Count the pulse
over a 30 sec period and then multiply by 2 to establish a rate per minute. In
determining pulse rhythm you may have to palpate or auscultate for a full
minute
— Respiration measurements: assessed by observation, palpation, auscultation
— Temperature measurements: use thermometers
-mercury (glass) with covers, electronic with probe covers, Ear thermometer with
probe covers, forehead strips
Temperature:
— 1. Rectal temperature
— 2. Oral temperature measurement
— 3. Axillary temperature measurement
— 4. Ear temperature measurement


Administration of intramuscular (IM)immunizations and medications

Administration of rectal medications

Administration of tuberculin skin test

Blood collection procedures
— A. Capillary blood: use to determine hct,glucose and bilirubin
a) Fingerstick method
b) Heelstick method

— B. Venous blood

e) External jugular vein- should be reserved for experienced phlebotomists
The external jugular vein crosses perpendicular to the sternocleidomastoid
muscle in line between the angle of the mandible and the middle of the clavicle. It
runs superficial and lateral to the carotid artery which should be located by
palpation and avoided
Pediatric emergency Procedures
— INDICATIONS FOR AIRWAY MANAGEMENT
— Respiratory failure or impending respiratory failure
— -Respiratory rates < 12 or > 60 plus non-purposeful or unresponsive to
painful stimuli
— Cardiopulmonary failure
— Shock - helps decrease the work of breathing
— •Emergency drug administration – lidocaine – epinephrine – atropine –
narcan (+ valium) – when no intravenous access in readily accessible
— Neurological resuscitation - pediatric GCS < 8 or consider in anyone with GCS
< 12 and decreasing mental status; hyperventilate to pCO2 of 30 - 35
— Protects the airway

— SUBCLAVIAN VEIN

SAPHENOUS VEIN CUTDOWN

— Bone marrow aspiration (BMA)
Preferred sites: Posterior iliac crest for most patients- easily accessible, easily
stabilized and distant from vital structures
Anterior iliac crest- also easily accessible esp in obese patients, closer to
vital structures, more painful
Anterior tibial tuberosity may be used in newborn patients
Aspiration from the sternum is contraindicated in children because of the
thinness of the bone and proximity to mediastinum

Urogenital procedures
— Transillumination of scrotum
— Urine specimen collection
Urine bag
Voided midstream
Catheter
Suprapubic aspiration


For suprapubic aspiration

Neurologic procedure
— Skull transillumination
— Lumbar puncture