PE23.9-11 | Gastrointestinal Procedures — Summary & Reflection

KEY TAKEAWAYS

Three essential paediatric procedural skills were covered in this module: (1) NG tube insertion — indicated for enteral feeding when oral route is unsafe or insufficient; NEX measurement determines depth; pH ≤5 on aspiration confirms gastric placement; never feed through an unverified tube; pulmonary misplacement is the most dangerous complication. (2) IV cannulation — standard route for all parenteral therapy; preferred sites in children are dorsum of hand, antecubital fossa, and saphenous vein; insert at 10–15°, advance the cannula off the needle after flashback; flush smoothly confirms intravascular placement; extravasation is the commonest complication. (3) IO access — emergency vascular access; indicated after 2 IV failures or 90 seconds in cardiac arrest; proximal tibia preferred site, 1–2 cm below tibial tuberosity on the anteromedial flat surface; 'give' on drilling confirms cortex penetration; all IV drugs and fluids can be given; remove within 24 hours; growth plate injury is prevented by correct landmark. Paediatric dosing is always weight-based (mg/kg). Simulation practice on manikins before supervised clinical exposure is the required learning pathway.

REFLECT

Think about the moment in the hook scenario — three failed IV attempts, a deteriorating child, and the decision to go IO. The fear of performing an unfamiliar procedure on a sick child is real and understandable. Deliberate practice on manikins exists specifically to bridge the gap between 'I know how to do it in theory' and 'I can do it under pressure in the dark at 11 PM.' Reflect on which of the three procedures you feel least confident about, and commit to a specific plan: how many manikin sessions will it take before you feel the muscle memory solidify? What is the one step you are most likely to miss under stress? Anticipating your own failure modes is a hallmark of procedural self-awareness — and the doctors who are safest in emergencies are those who have rehearsed not just the technique, but the decision of when and how to escalate.