COD 9: Performing core pediatric procedures

Key Features

• This EPA includes determining which procedures are necessary and appropriate to the situation.
• Procedures include: accessing port-a-cath; cardiopulmonary resuscitation (defibrillation); chest tube; ear curettage; G-tube reinsertion; immunization (intramuscular); immunization (subcutaneous); intubation; IV insertion; lumbar puncture with/without injection in preschool/school age child; managing occlusion in long-term access line; nasogastric tube; nasopharyngeal swab; obtaining an EKG; phlebotomy; surfactant administration; throat swab; umbilical arterial line; umbilical venous line; urinary catheterization
• Some procedures may be observed in a simulation setting, including Pediatric Advanced Life Support (PALS) or Neonatal Resuscitation Program (NRP) and/or mock codes.
• This EPA does not include other commonly performed procedures that are present in the other stages of training (Foundations).

Assessment plan

Direct observation by supervisor

Use form 2. Form collects information on:

• Procedure: access port-a-cath; cardiopulmonary resuscitation (defibrillation); chest tube; ear curettage; G-tube reinsertion; immunization (intramuscular); immunization (subcutaneous); intubation; IV insertion; lumbar puncture with/without injection; manage occlusion in long-term access line; nasogastric tube; nasopharyngeal swab; obtain EKG; phlebotomy; surfactant administration; throat swab; umbilical arterial line; umbilical venous line; urinary catheterization
• Setting: clinical; simulation
• Age: neonate; infant; preschool; school age; adolescent
• Gender: female; male

Collect 33 observations of achievement (those marked with an asterisk may be observed in simulation).

• At least 1 access port-a-cath*
• At least 1 cardiopulmonary resuscitation (defibrillation)*
• At least 2 chest tubes*
• At least 2 ear curettage
• At least 1 G-tube reinsertion*
• At least 2 immunizations (intramuscular and subcutaneous)*
• At least 3 intubations in neonates/infants
• At least 2 IV insertions, including one infant/preschool age
• At least 2 lumbar puncture with/without injection in preschool age/school age
• At least 1 manage occlusion in long-term access line*
• At least 3 nasogastric tubes in neonates/school age
• At least 1 nasopharyngeal swab
• At least 1 obtain EKG
• At least 3 phlebotomies
• At least 2 surfactant administration in neonate
• At least 1 throat swab
• At least 1 umbilical arterial line
• At least 2 umbilical venous line
• At least 2 urinary catheterization (1 in a boy; 1 in a girl)
   

CanMEDS milestones

1. ME 3.2 Obtain and document informed consent, explaining the risks and rationale for a proposed procedure
2. ME 3.4 Gather and/or manage the availability of appropriate instruments and materials
3. ME 3.4 Position the patient appropriately
4. ME 3.4 Demonstrate aseptic technique: skin preparation; draping; establishing and respecting the sterile field; hand cleanse, mask, gown and glove
5. ME 3.4 Select and provide sedation and local analgesia, as appropriate
6. ME 3.4 Handle sharps safely
7. ME 3.4 Perform the procedure in a skilful and safe manner
8. ME 3.4 Monitor patient comfort and safety, and adjust the procedure as needed
9. COL 1.2 Communicate effectively with patient and/or assistant(s) during the
   procedure
10. P 1.1 Work within personal limits, asking for assistance as needed
11. ME 3.4 Establish and implement a plan for post-procedure care
12. ME 3.4 Recognize and manage complications
13. COM 5.1 Document the procedure and outcome