DEBRE MARKOS UNIVERSITY

SCHOOL OF MEDICINE
Seminar on common pediatric procedures
Moderator: Dr Temesgen A. (MD , Pediatrician)
Presenters: 1. Yitayew Nigussie
2. Yechale Endalew
C1-medical students

1
 Outlines
 Introduction
 Indications
 Contraindications
 Equipment's
 Procedures
 Complications

2
 Objectives
Describe the indications, contraindications, methods and
equipments for common pediatric procedures like
• mask,
• NGT,
• LP,
• thoracenthesis,
• paracenthesis,
• IV cannulation,
• IO insertion,
• subdural tap
• urethral catheterization
3
 Introduction
• Practical procedures should first be explained to
the parents or to the child
• If she or he is old enough; any risks should also be
discussed with them and their consent obtained.
• Procedures on young infants should be carried
out in warm surroundings to avoid hypothermia.
Good light is essential.
• Older children should be told what is to happen
• Analgesia should be given when necessary

4
 Bag-Mask Ventilation
INDICATIONS
• To ventilate and oxygenate a patient.
• A ventilation face mask may be used with an
oropharyngeal or nasopharyngeal airway during
spontaneous , assisted, or controlled ventilation.
CONTRAINDICATIONS
• Relative
• In patients with full stomach, cricoid pressure must be
• maintained to avoid vomiting and aspiration.

5
 EQUIPMENTs
• Ventilation bags (manual resuscitator) come
in 2 types:
• self-inflating bag and flow-inflating
(“anesthesia”) bag.
• Ventilation bags used for resuscitation should
be self inflating.
• Ventilation bags come in different sizes:
infant, child, and adult.
6
• A ventilation mask consists of a rubber or
plastic body, a standard connecting port, and a
rim or face seal.
• Supplemental oxygen can be attached to
ventilation bags
• to provide oxygen to the patient

7
 PROCEDURE
Sequence
• Open the airway via
chin lift/jaw thrust
maneuver.
• Seal the mask to the
face.
• Deliver a tidal volume
that makes the chest
rise

8
 COMPLICATIONS

• Reduction in cardiac output.

• Excessive ventilation volume and airway
pressure may
• lower cardiac output by raising intrathoracic
pressure
• and distending alveoli, increasing afterload of
the right
• heart, and decreasing venous return

9
• Vomiting and aspiration.
• Air trapping, barotrauma, air leak, and
reduced cardiac
• output can be caused by excessive tidal
volume and rate in
• patients with small airway obstruction (eg,
asthma and bronchiolitis)

10
 Giving Injections
1. Intramuscular

In children aged > 2

years, give the injection
into the outer thigh or the
upper, outer quadrantof
the buttock, well away
from the sciatic nerve.

11
In younger or severely malnourished children,

• use the outer side of the thigh

• midway between the hip and
• the knee or over the deltoid
muscle in the upper arm

12
 2. Subcutaneous
• Select the site as described above for
intramuscular injection. Push the needle (23–
25-gauge) under the skin at a 45° angle into
the subcutaneous fatty tissue.
• Do not enter the underlying muscle

13
 3. Intradermal
• For an intradermal injection, select an
undamaged, uninfected area of skin (e.g. over
the deltoid in the upper arm).
• Stretch the skin between the thumb and
forefinger of one hand; with the other, slowly
insert the needle (25 gauge),
• bevel upwards, about 2 mm just under and
almost parallel to the surface of the skin

14
Intradermal injection

15
 Giving parenteral fluids
[Link] IV Insertion
It is the process of placing an IV line for a patient for
different purposes.
INDICATIONS
Vascular access in non emergent situations or
temporary access in emergent situations.
– Administration of fluids and electrolytes.
– Administration of intravenous medications.
– Administration of blood and blood products.
– Blood sampling
16
 CONTRAINDICATIONS
Absolute
• Do not insert through an infected site.
• Do not insert through a burn.
• Do not insert in an injured site.
Relative
• Avoid a paralyzed extremity.
• Do not insert in a massively edematous extremity.
• Do not insert an IV distal to injured organs (eg, do not
use lower extremities when treating abdominal
injuries).
• Avoid joint area.
17
 EQUIPMENT
• Gloves.
• Tourniquet or rubber band.
• Tape and occlusive transparent dressing.
• Alcohol wipes.
• Povidone or chlorhexidine.
• Syringe filled with injectable saline.

18
• Gauze pads.
• IV device: catheter or butterfly of appropriate
size to fit the patient and the task.
• Topical anesthetic cream.
• Ultrasound guiding equipment (if available
and if trained in its use)

19
 PATIENT POSITIONING
• Position the patient with the chosen site
closest to you.
• Have a helper gently restrain and distract the
child.
• Have the patient at a comfortable working
height.
• For external jugular line placement, have the
patient’s head lower than the trunk
(Trendelenburg)

20
• Accessible peripheral veins
include the following:
•

21
22
Inserting lV line into a scalp

23
Complications
• Infection.
• Hematoma.
• Skin ulceration.
• Air or particle embolism.
• Blood clot.
• Local ischemia.
• Phlebitis.

24
 Limb veins Scalp veins
-smaller peripheral veins -Minimal subcutaneous fat
-more subcutaneous fat -Less movement
-prone to vasoconstriction -The lack of a flexible joint,
-much less likely to remain which reduces the
motionless and cooperative likelihood of dislodging the
- they are likely to dislodge the catheter
catheter

25
 Central vein cannulation
• This should not be used routinely; only when IV access is urgent.
Remove the
• cannula from a central vein as soon as possible (i.e. when IV fl uid
is no longer essential or when a peripheral vein can be
cannulated successfully)

26
 Femoral Venous Catheterization
INDICATIONS
• Any situation that requires central venous
access.
• venous access that cannot be obtained
peripherally.
• An emergency resuscitation requiring
administration of large amounts of fluids.
• The need for central venous pressure
monitoring.
• Placement of a pulmonary artery catheter.
27
• The need for frequent blood draws.
• Infusion of hyperalimentation, concentrated
solutions (ie,KCl, dextrose concentrations
greater than 12.5%, chemotherapeutic agents,
hyperosmolar saline).
• Infusion of vasoactive substances (ie,
dopamine and norepinephrine) that can
extravasate and cause soft-tissue necrosis.
• The need for hemodialysis.

28
 Advantages of Catheter Placement
at Femoral Site

• It does not interfere with procedures or

monitoring
• involving the head, neck, or chest (such as
cardiopulmonary resuscitation).
• Pressure can be applied easily in the event of
femoral artery puncture or catheterization.
• It leaves the patient’s neck free of devices.

29
 Disadvantages of Catheter Placement
at Femoral Site
• It is a relatively “dirty” area (though this can
be managed with good sterile technique and
dressing changes).
• Placement of a long line is required for
central venous pressure monitoring.
• It can be challenging to place a pulmonary
artery catheter through a femoral venous
catheter

30
 CONTRAINDICATIONS

Absolute
• Severe abdominal trauma (provided that adequate
venous
• access can be obtained elsewhere)
Relative
• A patient with distorted anatomy or landmarks.
• Risk factors for excessive bleeding, such as
thrombocytopenia, coagulopathy, and
anticoagulant or thrombolytic therapy.
31
• Skin lesions (such as cellulitis, burns,
abrasions, or dermatitis).
• Conditions that predispose the patient to
sclerosis or thrombosis (such as vasculitis).
• Known thrombus of the femoral vein

32
 EQUIPMENT
• The catheter.
• An appropriate size guidewire (at least 2
times the length of the catheter).
• An appropriate size introducer needle.
• A tissue dilator if the catheter is larger than
3F.
• Two or three 3- to 5-mL syringes.
• 1% lidocaine and a 26-gauge needle to inject
the lidocaine.

33
• Skin preparation solution (either 2%
chlorhexidine-based preparation for patients
older than 2 months or 10% povidone-iodine).
• Sterile drapes.
• Scalpel blade.
• Suture (ie, 3.0 silk).
• Sterile gauze pads

34
35
 RISKS
• Bleeding (can usually be managed by applying
pressure to the site).
• Infection (can be minimized with the use of
good sterile technique during placement and
regular catheter care).
• Embolization of the guidewire if the operator
does not use proper technique.
• Vessel perforation.
• Embolization of a preexisting thrombus
36
 PATIENT POSITIONING
• Place the patient in the supine position.
• Raise the hips slightly to flatten the inguinal
area.
• Position the patient with his or her legs
extended or with
• the hips and knees slightly flexed in the “frog”
position

37
 COMPLICATIONS
During Catheter Placement
• Bleeding, the main complication, often results
from inadvertent artery puncture.
• Local hematomas.
• Bowel or bladder perforation.
• Air embolus.
• Catheter embolus.
• Creation of an arteriovenous fistula

38
 With Catheter in Place
• Infection
Swelling of the lower extremity, resulting from
impaired venous return
Deep venous thrombosis or inferior vena
cava thrombosis.
• Catheter knotting.
• Catheter malposition (ie, insertion into the
lumbar
• venous plexus, a potentially lethal complication)
39
 External jugular vein
• Hold the child securely, with the head turned
to one side away from the
• puncture site and slightly lower than the body
(15–30° head-down position).
• Restrain the child as necessary in this position.
• After cleaning the skin with an antiseptic
solution, identify the external

40
• jugular vein as it passes over the
sternocleidomastoid muscle at the junction of
its middle and lower thirds. An assistant
should occlude the vein to keep
• it distended and keep its position steady by
pressing over the lower end of the visible part
of the vein just above the clavicle.

41
• Pierce the skin over the
vein, pointing in the
direction of the clavicle.
A short firm thrust will
push the needle into
the vein. Proceed with
cannulation of the vein,
as described
• above for a peripheral
vein
42
 SUBDURAL TAP
• Is the process of drawing fluid from the
subdural space through a hollow needle or
cannula.

43
 INDICATIONS
Diagnostic
• To know the cause of the subdural empyema
Therapeutic
• Trauma
• Irritability
• Mental status changes
• Full or bulging of fontanel
• Third or sixth nerve palsies
• Unconsciousness, coma, seizures and hemiparesis
44
 CONTRAINDICATIONS

• Clinical instability when risk exceeds potential

benefit
• Uncorrected thrombocytopenia or bleeding
diathesis
• Infection in the skin or underlying tissue at or
near the puncture site

45
 EQUIPMENT
• Povidine-iodine
• Spinal needle
• Sterile tubes

46
 Cont’d
• Stretch skin overlying
the puncture site to
form a Z-track.
• Insert spinal needle or
over-the-needle
intravenous catheter
and release skin.

47
 THORACENTESIS
 Thoracentesis is a procedure used to obtain a sample of fluid
from the space around the lungs
 Normally, only a thin layer of fluid is present in the area
between the lungs and chest wall.
 However, some conditions can cause a large amount of fluid
to accumulate. This collection of fluid is called a pleural
effusion.
 Thoracentesis is done to collect a sample of the fluid, which
can help determine why the pleural effusion developed.

48
 Indication
• Therapeutic drainage of pleural
effusion in patient with respiratory
compromise when fluid is unlikely
to reaccumulate.
• Diagnostic evaluation of pleural
effusion of unknown etiology.
• Therapeutic removal of small
pneumothorax.

49
 CONTRAINDICATIONS

• Skin infection (e.g, herpes zoster)

at site of insertion.
• Bleeding diathesis, anticoagulant
therapy.
• Mechanical ventilation.

50
 EQUIPMENT
• Sterile gloves, mask, and gown.
• Iodinated skin preparation with sterile sponges
• Sterile towels.
• Local anesthetic (1% lidocaine without
epinephrine).
• 5-mL syringe with 25-gauge needle.
• 18-gauge 2-inch needle.
• 18–20-gauge angiocatheter.
• Collection basin.
• 3-way stopcock.
• 20–60-mL syring

51
 PATIENT
PREPARATION
• Patient should have intravenous
access.
• Oxygen should be available.
• Younger patients may need
sedation for procedure.
Pleural effusion.
• Sitting upright with arms supported
on table in front of patient
• Lying in lateral decubitus position
with effusion side down.
Pneumothorax: Supine with head of
bed up 30 degrees.
52
PROCEDURE
Locate Effusion
■ Chest radiograp.
■ Manual percussion to find onset of dullness.
• Ideal location is 1–2 cm below onset of
dullness.
• Effusion is usually accessible via the 6 or 7
interspace
• If pneumothorax is present, it is usually
accessible via the second intercostal space
anterior
■ Cleanse area in sterile fashion.
■ Drape surrounding area with sterile towels.

53
Numb the Area
•

■ Use a 25-gauge needle and 5-mL syringe to infiltrate the

skin and make a wheal under the skin.
■ Change needle to 18 gauge with 2-inch needle.
■ Going over top of sixth rib, infiltrate through wheal, over
top of rib to anesthetize the periosteum, and into pleural
space.
• Be sure to aspirate first, and know when you are in the
pleural space.
• The parietal pleura needs to be anesthetized, but, to avoid
a puncture of the lung, do not advance the needle further.
• When in the pleural space, a “pop” may be felt and fluid
or air will enter syring

54
 Removal of Pleural Effusion for
Diagnostic Evaluation

■ Remove lidocaine syringe and needle to outside the

pleural space, with needle still inserted but outside the
pleural space; replace syringe with empty 20–60-mL
syringe.
• Reinsert needle into pleural space while applying
gentle
negative pressure on syringe.
• When in pleural space, a “pop” may be felt and fluid or
air will enter syringe.
■ Remove effusion into syringe.
■ Remove needle and apply bandage to area.

55
56
57
 Therapeutic Removal of
Pleural Effusion
• Completely remove needle and syringe filled with
lidocaine.
• Insert angiocatheter into same track and enter pleural
space while applying gentle negative pressure.
• When in pleural space, a “pop” may be felt and fluid or
air will enter syringe.
• Remove inner needle, leaving catheter in place.
• Ensure that the stopcock is closed to pleural space and
chest wall or place a finger over the end of catheter to
avoid introducing air into chest wall and creating a
pneumothorax.

58
 INTERPRETATION AND
MONITORING
 The following laboratory tests should be
done on the fluid obtained during
thoracentesis:
 Protein levels.
 Lactic acid dehydrogenase levels.
 Glucose levels.
 Blood cell count and differential.
 pH levels.
 Gram stain.
 Aerobic and anaerobic culture.
 Other cultures as indicated (eg, viral, mycoplasma,
fungal).
 Analysis of these factors helps determine
whether the effusion is a transudate or an
exudate 59
COMPLICATIONS

• Pneumothorax.
• Bleeding: from intercostal vessel creating
subcutaneous
hematoma or hemothorax.
• Hypoxia.
• Pulmonary edema.
• Puncture of liver or spleen.
• Infection.
• Laceration of lung.

60
 NASOGASTRIC TUBE INSERTION
• Nasogastric tubes are flexible double or
single lumen tubes that are inserted
through the nose trills, down the
nasopharynx, and in to the stomach or the
upper portion of small bowel.

61
 INDICATIONS
• Decompression of the upper
gastrointestinal tract
(eg,pancreatitis, intestinal
obstruction).
• Gastric lavage.
• Enteral feeding.

62
 CONTRAINDICATIONS
Absolute
• Unstable airway.
• Intestinal perforation.
• Cervical spine trauma.
• Facial trauma.
Relative
• Coagulopathy (prothrombin time > 18
seconds).
• Thrombocytopenia (platelet count <
100,000/mcL).
• Recent intestinal tract surgery (< 1 63
 EQUIPMENT
• Lubricant gel.
• Nasogastric (NG) tube.
Larger diameter, polyethylene NG tube for
suction and decompression.
 Smaller diameter, silicone NG tube for
enteral feeding.
• Water or normal saline at room temperature.
• Drainage bag or feeding pump.
• 60-mL catheter tip syringe.
• Stethoscope
64
PROCEDURE
• Measure the length of insertion from the
nares to the ear
and to the epigastrium (Figure 25–1);
mark it on the tube
with an indelible pen.
• Lubricate tube with gel.
• Insert the tube through the nose (Figure
25–2).
• Ask the patient to cooperate by
swallowing while the tube
is being inserted.
• Advance the tube to the length mark. 65
• To check position, aspirate tube with 50-mL
syringe gastric aspirate (pH = 1–3) confirms
positioning in stomach.
• Insert small amount of air (20–30 mL) via NG
tube while listening to epigastric area of
stomach with stethoscope.
• If unsure about tube placement, verify tube
position by obtaining a chest film before
starting enteral feeding or drug treatment.
• Secure tube to the face with tap

66
67
 MONITORING

• Monitor intake and output volume.

• Evaluate tube position.
• Patient symptoms.

68
COMPLICATIO
NS
• Aspiration.
• Infection.
• Sinusitis (caused by long-term NG
tube feeding).
• Bleeding.
• Perforation.
• Mucosal tear

69
FOLLOW-UP
• Call a doctor when any of the
following clinical signs arepresent:
Fever.
Nausea and vomiting.
Melanotic stool or bright red
hematemesis.
Persistent abdominal pain.
 Abdominal distention.
Chest pain

70
 PARACENTESIS
• Abdominal paracentesis is a simple bedside
procedure in which a needle is inserted into the
peritoneal cavity and ascitic fluid is removed
• Diagnostic paracentesis
• refers to the removal of a small quantity of fluid
for testing.
• Therapeutic paracentesis
• refers to the removal of 5 liters or more of fluid
to reduce intra-abdominal pressure and relieve
the associated dyspnea, abdominal pain, and
early satiety

71
 INDICATIONS
• Diagnostic sampling of ascitic fluid
 internal bleeding following blunt
abdominal trauma
 chylous ascites after surgery,
 rule out malignancy,
 identification of infectious organism in
spontaneous bacterial peritonitis
• Therapeutic removal of the ascitic fluid
(eg, chylous ascites, tense ascites,
intestinal lymphangiectasia).

72
CONTRAINDICATI
ONS
Absolute
 Unstable airway.
 Hemodynamically unstable patient.
 Intestinal perforation.
Relative
 Infection of the abdominal wall.
 Coagulopathy (prothrombin time > 18 seconds).
 Thrombocytopenia (platelet count <
100,000/mcL).
 Recent intestinal tract surgery (< 1 month ago).

73
 EQUIPMENT

• Alcohol swabs, povidone-iodine.

• 23-gauge and 21-gauge needles or Angio
catheters with syringes.
• Local anesthetic (eg, 1% lidocaine).
• Large bore needle with plastic catheter.
• Sterile containers for fluid collection
• Appropriate culture tubes for microorganisms

74
 RISKS
• Pneumoperitoneum.
• Perforation: Intestine, solid organs.
• Bleeding.
• Infection.

75
 PATIENT
POSITIONING
• Supine or side.
• The preferred site is in the midline
approximately one third of the distance
from the umbilicus to the symphysis
pubis
• In infants, the fluid may bulge laterally,
and the paracentesis may be obtained
laterally to that point.

76
 PROCEDURE
• The puncture site should be shaved, if
necessary, and
cleansed with povidone-iodine.
• Inject local anesthetic, infiltrating the skin
first and then penetrating into deeper layers
• A small 3-mm incision can be made with a
scalpel to help insert the needle.
• Using Z-track technique, insert the tap
needle 1–2 inches into the abdomen

77
• Obtain a sample of fluid or withdraw as
much fluid as necessary with a syringe
• Remove the needle and apply a pressure
dressing to the puncture site.
• If an incision was made, it may be closed
using 1 or 2 stitches.
• The ascitic fluid removed may be
replaced 1:1 with 5% albumin IV.

78
Paracentesis

79
Complicatio
ns
• Pneumoperitoneum.
• Perforation: Intestine, organ.
• Bleeding.
• Infection.

80
FOLLOW-UP
• Call a doctor when any of the
following clinical signs is present:
 Fever.
 Nausea and vomiting.
 Blood in the stool.
 Abdominal pain.
 Abdominal distention.

81
 LUMBAR PUNCTURE
• Lumbar puncture is a procedure that is often
performed in emergency department to obtain
information about the cerebrolspinal fluid.
• It is usually used for diagnostic purpose to rule out
potential life threatening conditions
• sometimes used for therapeutic purpose
e.g pseudotumor cerebri

82
INDICATION
S
• Central nervous system (CNS) infection
(viral, fungal, or bacterial) or malignancy.
• Intracranial pressure or pseudotumor
• Metabolic studies.
• Aminoacidopathies.
• Neurotransmitter disorders
• Undiagnosed movement disorders.
• Undiagnosed infantile or pediatric epilepsy.
• Demyelinating disease (eg, multiple
sclerosis).

83
CONTRAINDICATI
ONS
Absolute
 CNS herniation.
 Unilateral mass lesion with edema or
mass effect.
Relative
 Suspected focal mass lesion.

84
EQUIPMEN
T
• Spinal needle: 0.5 inch for neonate,
22 gauge.
• Manometer.
• Sterile collection tubes (sufficient
number for studies).
• 3-way stopcock.
• Flexible tubing.

85
 RISKS

• Herniation (extremely rare) is associated

with focal structural lesions causing
increased intracranial pressure.
• Infection (extremely rare).
• Headache (rare).
• Back pain.

86
PATIENT POSITIONING
• Lateral decubitus position.
• Back arched in extreme lordosis.
• Spine should be as perfectly horizontal as
possible.
• Sacral plane should be as vertical as possible
(Figu
• Spinous process of L4 is on line drawn between
iliac crests.
• Cauda equina is in mid lumbar [Link]
processes are angled inferiorly (caudally)

87
88
PROCEDURE
• Palpate for L4 spinous process using iliac crests as
landmarks .
• Place lumbar puncture needle between
interspaces L4–5.
• Angle the needle tip approximately 15–30 degrees
from
perpendicular to plane of back in rostral direction,
aiming
toward umbilicus.
• Needle remains fixed in horizontal plane to back.
• Advance needle slowly until light resistance (a
pop) is felt.
• Remove stylet and check for CSF flow.
89
• If no CSF flows, continue to advance the needle slowly.
• If CSF flows, connect flexible tubing to hub of lumbar
puncture needle.
• Allow CSF to flow through tubing into manometer.
• Hold base of manometer and stopcock at level of
heart.
• Straighten the patient’s back and legs.
• When CSF stops advancing along manometer,
measure
opening pressure at meniscus.
• Collect CSF for studies.
• Measure closing pressure, if needed.

90
COMPLICATION
S
• Cerebral herniation.
• Infection.
• Headache.
• Back pain.

FOLLOW-UP
• Sterile dressing.
• Older adolescents should rest in bed for
1–3 hours.

91
 Straight urethral catheter
• Bladder catheters are used for urinary
drainage, or as a means to collect urine for
measurement.
• Many clinical situations are appropriate for the
placement of catheter
• Daily evaluation of the ongoing need for the
catheter is essential to reduce complications.

92
INDICATIO
NS
• Diagnostic evaluation.
• Temporary relief of urinary retention.

CONTRAINDICATIONS
Absolute
• Suspected urethral injury (eg, blood at
meatus, laceration).
• Unable to identify urethra (eg, labial
adhesion).
• Neutropenia.

93
EQUIPMEN
TS
• Urinary catheters
• Sterile collection cup.
• 10% povidone-iodine (or equivalent).
• Castile soap.
• Sterile gloves, drapes, and gauze.
• Lidocaine (2%) anesthetic jelly or water-
based lubricant

94
RISK
S
• Urethral trauma.
Hematuria.
Pain (common).
• Psychological stress (common, as
child is restrained for procedure).
• Catheter mishaps (eg, knot forms in
bladder)
• All equipment should be latex free.
Allergy to latex is common,
particularly in certain population
95
 PATIENT
PREPARATION
• Keep the patient covered until ready to begin.
• Good lighting is helpful.
PATIENT POSITIONING
• The child is placed supine.
• The female patient is placed in the frog-leg
position.
• The male patient is placed with legs extended.
• Wear sterile gloves.
• Use 1 hand to touch the patient if necessary,
while keeping the hand with the catheter clean

96
Male
A. Circumcised Boyes
• The glans and the distal phallus are cleaned with a
10%
povidone-iodine solution.
• The penis is held gently retracted away from the
body in
the nondominant hand, with the penis held at about
a 90-
degree angle to the body.
• The catheter is lubricated with a water-based jelly
with or
without lidocaine and passed directly through the
meatus
downward (not angled rostrally).

97
• Some resistance may be felt at the
prostate level, which can be overcome by
using steady pressure.
• Do not push and pull the catheter to get it
to pass.
• Once urine is visible in the catheter or
collection cup, stop advancing the catheter.
• Remove the catheter gently after the
sample is obtained.

98
99
 UNCIRCUMCISED
BOYS
• The procedure is the same as in
circumcised boys, except that the
foreskin is prepared first and then
the foreskin is retracted just to the
point that the meatus is visible.
This
area is then prepared as well.
• The catheter is inserted in the
same fashion as above.
• The foreskin is then returned to the
normal position 100
Fema
le
• The periurethral area and labia minora
and majora are prepared with a 10%
povidone-iodine solution.
• The catheter is lubricated with a water-
based jelly with or without lidocaine and
is passed into the urethra and directed
straight downward toward the bed or
very slightly rostrally.
• In smaller children, vaginal tissue can
obscure the urethral opening;

101
• The first portion of the urine may be
discarded; this is analogous to a mid-
stream urine collection. This is only
possible if the collection system is not a kit
with the collection vial attached to the
catheter.
• Applying pressure of the suprapubic area
(Credé maneuver) may force out additional
urine.
• Remember to remove residual povidone-
iodine from the skin.

102
103
COMPLICATIO
NS
• Pain.
• Hematuria.
• Dysuria with or without urinary retention.
• Paraphimosis, resulting from failure to
reduce the foreskin after the procedure.
• Catheter knot (in infants, caused by
advancing small catheters too far,
allowing catheter to knot; may require
cystoscopy or surgical removal).

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FOLLOW-
UP
• Dysuria and hematuria complications are
transient
• Infants and toddlers who have dysuria and
refuse to void can be placed in a warm bath,
which promotes voiding.
• Ongoing symptoms would be unusual and
should prompt a new visit and evaluation,
with consideration of other causes of the
symptoms (eg, inadequate treatment of an
infection).

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 References

• [Link], Current pediatric procedures

• [Link] book of Hospital care for
childrem,2013 edition

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THANK YOU !!!

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