The Royal Children's Hospital Melbourne

For health professionals

The information on this page provides education and resources to health care professionals.

The core principles of procedural pain management are:

• Pharmacology: procedural sedation( oral, IV and inhaled), topical anaesthetic agents and acute pain agents.
• Sucrose - administered infants and children up to 18 months of age
• Positioning for comfort - upright positioning for procedures which empower the child and promotes comfort
• Distraction/diversion activities -toys, books, media, music, relaxation and breathing, guided imagery.
• Preparation parent and child for both the procedure and available coping strategies
• Language: developmentally appropriate words, positive coping language and order and sequence to explain procedure steps.

Quick links:

• Procedural Pain Management Guidelines  
• Procedural Pain Managment Policy

• Nitrous Oxide Accreditation 

  • Procedural Sedation Teaching Package ( wards,ambulatory and outpatient areas)
  • Orientation Package for nitrous oxide- how to guide
  • Procedural Sedation Nitrous Oxide Accreditation Tool- skill
  • Procedural Sedation Nittrous Oxide Accreditation Tool- theory

 

Orientation to new Nitrous oxide units: nitrous oxide sedation in the New Hospital will be delivered by new equipment which differs from the current equipment. Staff will need to be re-accredited before using the new equipment. The leaders and super trainers will then be re credentialing other RCH staff. 

End User Training Dates: For staff who cannot arrange re credentialing from a local Procedural Sedation Leader or Super user, further training sessions are available on the following dates: Thurs 24th of November 1030 -1130 and Friday 25th November 130-1130 AM.Please register  www.surveymonkey.com/s/enduserregistration

Workshops :

Procedural Pain Management

Please download the following application form from the link below. All RCH staff will need to have approval from the manager to attend the workshops.Non RCH staff please contact the Comfort Kids Program Manager if you are interested in attending the workshop:Comfort Kids Workshop Internal Registration  /External Registration 

Workshops location:  Location to be announced in November 2011  Time: 0800-1600 hours.

Pre reading material: the suggested three articles were selected to support the main themes of the workshop.  Pre reading one, Pre reading two, Pre reading three.

Procedural Sedation Leader -The Procedural Sedation Leader Workshop is designed to train staff members to become the nitrous oxide trainer in their clinical area.  Staff who attend this workshop must be accredited to deliver nitrous oxide before attending the workshop. The trainer is the designated staff member who is accountable to accredit staff in their department or ward. PSL are accountable to train at RCH only.

Procedural Sedation Leaders Workshop - the PSL training day for 2012 are:  March 28 and July 5th, register online.

Non Pharmacological

• Positioning for comfort
• • Positioning infant fact sheet
  • Positioning child fact sheet
  • Positioning resources: Article one.

• Preparing children

  • Resource article one,

• Distraction and diversion:

  • Distraction box program is a resources provided by the Comfort Kids Program to all RCH wards and departments. Quarterly the boxes are restocked or new items are introduced. Starting April 2011 RCH wards/departments will nominate a staff member to pick up restock packs from the Comfort kids Program office. Restocking will only be available during first week of: January, April, July and November 2011.
  • Private practice clinic and Murdoch will be charged a nominal fee for distraction box and restock. Please make arrangements with program manager lisa.takacs@rch.org.au

Quick guide to procedural pharmacology/ distraction/ guidelines

Topical Anaesthetics	Quick tips: Topical cream referred to as "numbing cream" rather than magical cream Inform the child,why cream applied to multiple sites e.g "help you pick out the best vein for the event." Use word " plastic straw" to refer to cannula and explain that it, "gives your body a drink or medicine that cannot be eaten" Important to let the child know that their body will tell us ( health care team) when its time for the drip to come out. Try not to promise a set number of days. Explain "why" behind the blood test e.g "measure salts,sugars or count how many red, white cells you have."
AnGel ( RCH brand) Made by Orion Laboratories www.orion.net.au	AnGel is a  RCH brand of topical anaesthetic 5g or 30g tubes of Amethocaine 4% in a white, opalescent gel base. Refrigerate unopened tubes to maintain shelf life (up to 6 months) Discard 30 days after opening Applied for a minimum of 45 minutes for venous cannulation or blood sampling Removed at 60 minutes and anaesthesia persists for 4-6 hours after the gel is removed
EmlaTM	Emla is a topical anaesthetic agent in tubes of 2.5% Lidoocaine/ Prilocaine in a 5% emulsion ( oil in water)  Stored at room temperature. For venous cannulation or blood sampling apply for a minimum of 60 minutes and remove.
Procedural sedation agents	Procedural Sedation Program for wards and outpateints( under devlopment) Procedural Sedation - Emergency Department Quick facts:Dose guideline for procedural sedation agents Oral/ overview of drugs available and dosage Intravenous overview of drugs available and dosage Inhaled agents: nitrous oxide - quick overview and drug/dose
Nitrous oxide equipment	Location of nitrous oxide units: Ambulatory, outpatient and  wards ( 8th, 6th, 5th, 4 main, 3 east) are equipped with portable units ( trolley and gas cylinders). Medical Imaging, Dentistry and Emergency Department are equipped with piped nitrous oxide units.   Spare units: if you require a second unit please make arrangements to borrow one from an ambulatory or ward area. Reporting faulty unit: Remove the unit from the clinical area for patient safety. Send nitrous oxide unit to Biomedical Engineering and contact Comfort Kids Program x7933 to obtain a spare unit during business hours ( 0800-1700 hours) or  borrow one from an ambulatory or ward area.  Imprest items: all disposable equipment for nitrous oxide should be part of ward and ambulatory Imprest system this includes disposable circuit and masks ( various size) Reservoir bag: the green reservoir bag on the nitrous oxide unit should be intact without tears or holes. Replacement reservoir bags are avaialble from the emergency equipment box ( black toolbox) located PICU x-ray viewing room.   Requesting Gas cylinders: All requests for the delivery of Medical Gases (depts.. not on the Gas Impress Delivery Schedule) can be requested by filling in a Requisition For Gas and faxing the requisition to stores on ext 7904. .Note - Allow 48hrs for Delivery. Also, Urgent requirements after 3.00pm weekdays, can be arranged via Security. Requisition For Gas Gas Imprest Delivery Schedule
Sucrose	Clinical Practice Guidelines- Sucrose Sucrose Fact Sheet- Be sweet to me baby. RCH bottled Sucrose obtained from RCH pharmacy.  Stored in refrigerator, one month expiry date. Pre packaged Sucrose @ RCH -Toot sweet Pre packaged Sucrose - send a  Purchase Requisition Form to Materail Resources wiht the item number  1040027-100, Supplier name: JLM Acute Health Care. (100 vials per box)  Pre packaged Sucrose - manufactuers details
Guidelines	Procedural Pain Management Guidelines Procedural Sedation Guideline Clinical Practice Guidelines- Sucrose
	Fact sheets for parents Midazolam/Chloral Hydrate Nitrous oxide prep book Nitrous oxide Reducing children's distress Medical Imaging information

 

Contact the Comfort Kids Program

 If you would like additional information about the website or program or feedback about the website to: lisa.takacs@rch.org.au