Positioning for procedures

  • Positioning for procedures
    • Femoral venipuncture
      • Nurse places the child supine with the legs in a frog position to provide extensive exposure of the groin area. 
      • Infant’s legs can be controlled by the nurse’s forearms and hands. 
      • Only the side for venipuncture is uncovers so that the practitioner is protected if the child urinates. 
      • Apply pressure to the site to prevent oozing from the site.
    • Extremity venipuncture or injection
      • Most common sites for venipuncture are the veins of the extremities, especially the hands and arms. 
      • A convenient position is to place the child in the parent’s lap with the child facing towards the parent in a straddled position. 
      • Place the child’s venipuncture site on a firm surface, the nurse can partially stabilize the outstretched arm and the parent’s can hug the child
    • Lumbar puncture
      • A flexed sitting or side-lying position may be used, depending on the child’s ability to cooperate and whether sedation will be used
      • The sitting position may interfere with chest expansion and diaphragm excursion, and in infants the soft, pliable trachea may collapse. 
        • Therefore, observe the child for difficulty with breathing.
      • Take vital signs as ordered and observe the child for any changes in level of consciousness, motor activity, and other neurologic signs.
    • Bone marrow aspiration or biopsy
      • Position for a bone marrow aspiration or biopsy depends on the chosen site. 
      • In children, the posterior or anterior iliac crest is most frequently used, but in infants, the tibia may be selected because it is easy to access the site and hold the child. 
      • If posterior iliac crest is used, child should be laying prone.

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