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should be carefully inspected before a specific venipuncture site is chosen. Pediatric Nursing and child health care 27 The following are considered when selecting a site for venipuncture. • Condition of the vein • Type of fluid/ medication to be infused • Duration of the therapy • Patients age and size • Skill of the health provider Possible Sites: • Scalp veins • Femoral Veins • External jaguar Veins • Antecubital –fossa 3.2 Indications and use of NG-tube: Gavage feeding (nasogastric or NG-tube feeding) is a means of supplying adequate nutrition to an infant who is unable or tires too easily to suck or to an older child who can not drink. To prepare for Gavage feedings, the space from the bridge of the infant’s nose to the earlobe to a point halfway between the xiphoid process and the umbilicus is measured against a No 8 or 10 Gavage tube for children over one year measure from the bridge of the nose to the earlobe to the xiphoid process. The tube is marked at this point by a small Kelly clamp or Pediatric Nursing and child health care 28 piece of tape to ensure that it reaches the stomach after it is passed. The tip of the catheter may be lubricated by water. An oil lubricant should never be used. Although the tube is passed into the stomach, it is occasionally passed into the trachea accidentally, oil left in the trachea could lead to lipoid pneumonia, a complication that a child already burdened with disease may not be able to tolerate. Once you are assured that the catheter is in the stomach, attach a syringe or special feeding funnel to the tube. Be certain that the child’s head and chest are slightly elevated to encourage fluid to flow downward into the stomach. Then feed with funnel or syringe and allow it to flow by gravity into the child’s stomach. When the total feeding has passed through the tube, the tube is reclamped securely and then gently and rapidly withdrawn to reduce the risk of aspiration. If the tube is to be remain in place, it should be flashed with 1 to 5 ml of sterile water and cupped to seal out air. Indications for NG tube: • Prematurity • Neurologic disorders • Respiratory distress • Severe protein energy malnutrition • Cleft palate Pediatric Nursing and child health care 29 3) Resuscitation: Respiratory arrest means that there is no apparent respiratory activity. The child will be unresponsive, pale and dead like. Cardiac arrest follows quickly after respiratory arrest as soon as the heart muscle is affected by the anoxia, which occurs. The outcome for the child will depend to great extent on the speed with which resuscitation is began. The steps for resuscitation can be remembered as “A, B, C, D” where A is for airway, B for breathing and C is for circulation and D is for drug administration. These three techniques (clearing the airway, ventilating the lungs, and circulating the blood by cardiac compression) will provide adequate oxygenation to major body organs for an extended period of time (A: clear airway, position, suction), (B: bagging, oxygen administration), (C: Cardiac compression, secure IV line), (D –drugs (epinephrine). Oxygen administration: Oxygen administration elevates the arterial saturation level by supplying more available oxygen to the respiratory tract. Nursing care must be planned carefully when children are in tents: • The tent should be open as little as possible so that as high an oxygen concentration as possible can be maintained. • Oxygen may be delivered to an infant by use of plastic mask. This tight fitting plastic can keep oxygen concentration at nearly 100 %. Pediatric Nursing and child health care 30 • A nasal catheter used with an oxygen flow of 4 L/ min provides a concentration of about 50 %. Most children do not like nasal catheter because it is irritant; assess the nostrils of the infant carefully when using nasal catheter. The pressure of catheter can cause areas of necrosis, particularly on the nasal septum. • Oxygen must be administered warmed and moistened, no matter what the route of delivery; dry oxygen will dry and thicken, not loosen secretions. • Oxygen must be administered with the same careful observation and thoughtfulness as any drug. • If concentrations are too low, oxygen is not therapeutic • In concentrations greater than those desired, oxygen toxicity can
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