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.
Analgesia and sedation for procedures
For some procedures (e.g. chest tube insertion or femoral cannulation), sedation with diazepam or light anaesthesia with ketamine should be considered (see section 9.1.2).
For diazepam sedation, give 0.1–0.2 mg/kg IV. For ketamine, give 2–4 mg/kg IM; this takes 5–10 min to act and lasts for about 20 min.
When giving any sedation or light anaesthesia, manage the child’s airway, beware of respiratory depression, and monitor oxygen saturation with a pulse oximeter, when possible. Make sure you have a resuscitation bag available and, if possible, oxygen.
Wrapping the child to hold him or her securely during a practical procedure
One end of a folded sheet should be pulled through under the arms on both sides (A and B). The other end is then brought across the front and wrapped around the child (C and D).