med admin/ IM injection, IV starts: lab

Question 1

med giving

Answer 1

o If giving tablets or pills – should be crushed, however make sure the drug can be crushed!

o When giving PO, important to prevent aspiration, particularly if child is crying. Place in seated or semi-
reclining position in lap. Place syringe along side of tongue and give in small amounts allowing for the

child to swallow. NEVER add to formula because infant/child may refuse unless the med is due before
a feeding, this may be a method that can work for you. Older children can be taught to use the syringe.
Infants can suck medications from a nipple, but be aware that residual may be left behind. Never mix in
sippy cups or any other large amount of liquid. Use a “chaser” after the med is given.
o If the child refuses (and don’t ask them if yes or no they would like their medicine) – give the child an ice
pop to numb the mouth, give a “chaser” after the drug, if there is nausea give a carbonated beverage
before/after medication, pharmacists can add “flavorings” to medications

Question 2

IM newborns

Answer 2

25 gauge, 5/8-7/8 inch needle. Preferred site is vastus lateralis. stabilize the infant’s leg and insert needle to the hub at 90 degree angle.

Question 3

IM infants 2mo+

Answer 3

General guideline to start with is 1” needle, 25 gauge.
1 ml is usually maximum amount administered in a single site for older infants/small
children.
VL: 0.5 ml in infants and 2.0 ml in child

Question 4

IM toddlers 12mo

Answer 4

preferred site thigh (one inch), deltoid (5/8 inch).

Question 5

IM Children (3-18 years)

Answer 5

– Deltoid – 22-25 gauge, 5/8 – 1 inch. Important to consider body mass!

Question 6

restraints

Answer 6

o Burrito Wrap swaddling
o Arm/leg/elbow restraints (no’s-no’s)
o Papoose board – NO for injections!!!!!
o Parent holding child with child facing parent leaving extremity exposed
o Have child cross arms over chest and lean over them
o Have someone lean over legs (no pressure on joints)
o Side lying position for LP’s for children, can use sitting position for infants
• Alternative approach – therapeutic holding which is the use of a secure and comfortable holding position
with the caregiver or parent for less than 30 minutes.

Question 7

IV gauge

Answer 7

smallest

Question 8

Where should I place a PIV in a pediatric patient?

Answer 8

• Start distal to proximal
• Look at both sides first before selecting vein
• Think about the child’s age/developmental level!
• Are they mobile?
• Which hand is there dominant hand?
• Do they like to text or play video games? This requires using hands, bending of arms!
• School age children like choices!!!
• Try to avoid using big veins in the middle arm if you suspect your patient may need long term IV antibiotics
because these are the preferred sites for PICC lines.

Question 9

sites based on age

Answer 9

▪ Infant: hand, foot, scalp (if no other site available up to 9 months of age)
▪ Toddler: if walking, avoid feet
▪ Child: keep in mind mobility and “handedness”, superficial veins of forearm
▪ Adolescent: keep in mind “handedness”, superficial veins of forearm, let them help chose
which vein to use
▪ Be careful with the use of tourniquet on children with fragile skin – make sure if using
rubber bands as tourniquet to place piece of tape on the band for easy and quick removal