Hold the infant's head still. Nurse: Cleanse the scalp area with antiseptic. Stabilize the scalp vein with non-dominant hand. Insert the catheter bevel up at a 30 degree angle. Watch for flashback of blood in the catheter hub. Advance the catheter fully into the vein. Remove the stylet and attach the IV tubing. Secure the site with transparent dressing.

2. Pediatric Life Support

3. Objectives
 What is cardiopulmonary arrest.
 What is the meaning of basic and
advanced life support.
 Basic life support.
 Advanced life support.
 Home message.

4.  What is cardiopulmonary arrest

5. In children, Secondary Cardiopulmonary
Arrests, caused by either:
Circulatory or
Respiratory Failure,
Are more frequent than primary arrests
caused by arrhythmias.

7.  What is the meaning of basic and
advanced life support.

8. Advanced
Basic
Place
Personel
Equipments

9.  Basic life support

10. Approach safely
Check response
Shout for help
Open airway
Check breathing
30 chest compressions

11. APPROACH SAFELY!
Scene
Rescuer
Victim
Bystanders
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

12. CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

13. Shake shoulders gently
Ask “Are you all right?”
If he responds
• Leave as you find him.
• Find out what is wrong.
• Reassess regularly.
CHECK RESPONSE

14. SHOUT FOR HELP
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

15. OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

16. Open Airway
 Head Tilt  Chin Lift
 Neutral positon in infants
and sniffing position in
Children
 If Suspected C-Spine injury
 Jaw thrust
 5 rescue breathes

18. CHECK BREATHING
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

19. CHECK BREATHING
 Look, listen and feel
for NORMAL
breathing

20. RESCUE BREATHS
 Pinch the nose
 Take a normal
breath
 Place lips over
mouth
 Blow until the chest
rises
 Take about 1 second
 Allow chest to fall
 Repeat

21.  Check pulse
 Carotid artery
 Brachial or femoral arteries

22. Chest compression

23. 30 CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

24. • Place the heel of one hand in
the centre of the chest
• Place other hand on top
• Interlock fingers
• Compress the chest
– Rate 100 min
– Site lower end of the sternum
– Depth 4-5 cm
– Equal compression : relaxation
• When possible change CPR
operator every 1 min
CHEST COMPRESSIONS

25. CONTINUE CPR
2
30

26. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths

27. Don’t interrupt resuscitation until
 Signs of life
 More healthcare workers
 Become exhausted

28.  The order of assessment and intervention for
any seriously ill or injured child follows the
ABC principles.
 A indicates Airway.
 B indicates Breathing.
 C indicates Circulation.

29. 1) Oropharyngeal airways

31. Sizing of the oropharyngeal airway

34. 2) Nasopharyngeal airways

36. OXYGEN AND VENTILATION

37. Face masks

38. Advantages:
 Quick and easy to setup and apply.
 Often found at the head of the bed in emergency areas .
Disadvantages:
 Nonspecific FiO2 (Dependant on patients inspiratory flows(
 Maximum FiO2 estimated at 50%
 Not intended for long term use.

39. Non-Rebreather Mask

40. Advantages:
 Fast and easy to set up.
Disadvantages:
 Delivers only one FiO2 100%
 FiO2 is extremely variable. While theoretically
capable of delivering an FiO2 of 100%,
realistically it is more likely between 60 and 80%
due to air entrainment around the mask.

41. Venturi Mask

43. Guide to colours of Venturi valves
O2 %
Flow (L/min)
Color
24%
2
Blue
28%
4
White
31%
6
Orange
35%
8
Yellow
40%
10
Red
60%
15
Green

44. Advantages:
 Administers a specific FiO2.
 Quiet.
Disadvantages:
 FiO2 only available according to mask
adapters. 24, 28, 31, 35, 40 and 50%.

45. Nasal Cannula

47. Advantages:
 Comfortable for patient.
 Ideal for oxygen dependent patients requiring small
amounts of oxygen.
Disadvantages:
 Maximum estimated FiO2 40%.
 Not appropriate for patients in respiratory distress.

48. Oxygen Tent

50. Ambu Bag

51.  Self-inflating bags come in three sizes:
250 ml, 500 ml, and 1500 ml.
 Without a reservoir bag it is difficult to
supply more than 50% oxygen to the
patient, whatever the fresh gas flow,
whereas with it an inspired oxygen
concentration of 98% can be achieved.

52. 4) Tracheal Intubation
 This is the preferred method for airway
control during cardiopulmonary
resuscitation.
 Ventilation with 12–15 l/min (95%) oxygen
using a bag–valve–mask should be
recommenced before, and in between, any
further attempts at intubation.

53. Rapid sequence intubation
 Pre oxygenate by 100% O2
 Sedation
 Atropine

59. Diameter:
 Full Term Infant  3.0 – 3.5 ID.
 Infant < 1 year  4.0 – 4.5 ID.
 > 1 year  (Age)
4
+4

60. Distance of Insertion:
 Length (cm) = (Age) + 12 for oral tube.
 Length (cm) = (Age) + 15 for nasal tube.
2
2

63.  The LEAN drugs:
(Lidocaine, Epinephrine, Atropine, Naloxone)
can be given by the ET route.
 ET administration of epinephrine requires
about 10 times the IV dose,
 Flush with 5 mL of normal saline, and
followed by three to five positive-pressure
breaths.

66. ShockableRhythm
Ventricular Fibrillation

67. ShockableRhythm
Pulseless ventricular tachycardia
Treated in the same way as VF

68. Non-ShockableRhythm
Asystole

69. Non-ShockableRhythm
Pulseless electrical activity

71. Sites of Paddles in defibrillation

72. Peripheral line
insertion

73. Introduction
Indication
Anatomy
Equipment
Procedure

74. INTRODUCTION
 Venipuncture and peripheral venous
access remain two of the most common
yet most challenging procedures in
pediatric medical care.

75.  Venipuncture, as the name implies,
consists of puncturing a vein, and it
continues to be the primary method of
obtaining blood samples in children.

76.  Peripheral venous access provides a
means of:
Maintaining or replacing body stores of fluids
or blood volume,
Restoring acid-base balance,
Administering medications.

77. Peripheral cannula
 This is the most common intravenous
access method in both hospitals and pre-
hospital services.
 A peripheral IV line (PIV) consists of a
short catheter (a few centimeters long)
inserted through the skin into a peripheral
vein

80.  22-24g - pediatric applications or
occasionally in adults with very small veins
 20g - standard, multipurpose adult IV
 18g - suitable for higher flow rates in
adults and for routine administration of
blood products
 14 - 16g - large (painful) catheters
reserved for situations where volume
resuscitation is needed or anticipated.

81. Butterfly needle OR scalp vein

82.  Butterfly Catheters are generally used only
in pediatrics and for very short-term
venous access, as they tend to perforate
veins easily and are more prone to
infection. Sizes 20 - 24g.

84. INDICATIONS

85. INDICATIONS
1- Obtaining venous access is indicated
in:
 Need for medications,
 Fluids,
 Blood products, or
 Contrast material.
 Nutrition (TPN).

86. Examples of such situations are
numerous and include:
 Volume depletion,
 Respiratory compromise,
 Cardiac abnormalities,
 Infection,
 Multisystem trauma.
 Severe pain,

87.  2-life-threatening condition(pediatric
resuscitations) requires placement of a
peripheral intravenous line as a means of
ensuring adequate access should a
complication develop.
 For, peripheral venous access is the
accepted mode to treat the patient.

88. Absolute contraindications
 Cutaneous infection overlying the vein
chosen for cannulation,
 Presence of phlebitis or thrombosis of the
vein,
 Marked edema of the extremity.
 Poor perfusion

89. Complications
 Cutaneous infection overlying the vein
chosen for cannulation,
 Presence of phlebitis or thrombosis of the
vein,
 Hemorrhage.
 Poor perfusion

90. ANATOMY

91. ANATOMY
 Sites available for peripheral venous
cannulation include multiple locations in
the:
Upper and lower extremities,
The scalp,
The external jugular vein.
 The veins are larger and generally easier
to locate in adults than in children.

92. Upper Extremity
On the dorsum of
the hand, the
most commonly
used veins are
the tributaries of
the cephalic and
basilic veins and
the dorsal venous
arch

94. Lower Extremity
The saphenous
vein, which is
situated about 1
cm above and in
front of the
medial malleolus,
is a good choice
for cannulation

95.  Veins of the dorsal
arch of the foot also
may be accessed.

96.  The anterior and
posterior tibial veins
form the popliteal
vein, which continues
as the femoral vein.

97.  Scalp veins are prominent in infants, especially those
under 3 months of age.
 Scalp veins may be accessed in patients up to the age of
about 9 months if the hair is relatively thin.
 The scalp veins are closer to the surface and are
supported underneath by the bony cranium

99.  The external jugular vein: is usually
cannulated by physicians rather than
nurses because of its location.
 It is typically used only when cannulation
of other peripheral sites is unsuccessful or
when considerable time may be saved in
managing a critically ill infant or child.

101. Equipment

102.  Gloves.
 Tourniquet or rubber band.
 Tape and occlusive transparent dressing.
 Alcohol wipes.
 Chlorhexidine.
 Syringe filled with injectable saline.

103.  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).

104. Procedure

105. Upper and Lower Extremities
 Apply tourniquet.
 Identify the blood vessel by palpation,
visualization, transillumination, or
ultrasound.

106. Upper and Lower Extremities
 Release the tourniquet, cleanse the site.
 Inspect the integrity of the catheter/stylet
assembly.
 Flush the catheter and the connecting tube
with saline.

107.  Reapply the tourniquet.
 Use your nondominant hand to apply
traction on the skin linearly or
circumferentially in order to stabilize the
vein.
 Enter the skin at a 30- to 45-degree angle
proximal to or alongside the vein.

109.  Reduce the angle as you advance the
catheter and enter the vein.
 Watch for blood flashback in the hub of the
catheter.
 Stabilize the catheter with the thumb and
middle finger of your dominant hand and
advance the catheter over the stylet using
the tip of your index finger.

111.  Remove the stylet.
 Do not reinsert the stylet once it has been
removed; it may damage the catheter.
 Release the tourniquet.
 Connect the extension tubing and saline-filled
syringe to the catheter.
 Gently flush the catheter; observe for
swelling, mottling, or color changes in the
extremity.

112.  Secure the IV with occlusive transparent
dressing and tape.
 Make a small loop in the IV tubing and tape it
across.
 Attach the line to an IV infusion assembly and
turn the pump on.
 Dispose of all sharp instruments in the proper
secure container.

113. External Jugular Vein

114. Scalp IV