2013

PEDIATRIC SKILLED
NURSING POLICY AND
PROCEDURE MANUAL

Sample Home Health

Agency

Pediatric Nursing is a nursing specialty that is provided to children in their places of

residence. Because of this service, children who would otherwise be in hospitals or
long term institutions can enjoy the comforts of home and family.

These procedures were designed to be used in conjunction with the home health care
general policies prepared by 21st Century Health Care Consultants.

This manual contains the most current federal regulations and practices to the best of
our knowledge. However the information in this manual may change from time to time
consistent with federal and state regulations.

21st Century Health Care Consultants disclaim responsibility for any adverse effects
resulting directly or indirectly from the use of this procedure manual, from any
undetected errors, and from the users misunderstanding of the text.

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Table of Contents
SECTION I - SKILLED NURSING ................................................................................. 10
1.01STERILE TECHNIQUE PROCEDURE .................................................................. 11
1.02CAST CARE........................................................................................................... 12
1.03SPICA CASTS AND BODY CASTS ....................................................................... 14
1.04BUCKS TRACTION............................................................................................... 15
1.05CATHERIZATION CARE OF INDWELLING URINARY CATHETER .................. 17
1.06CATHERIZATION INSERTION OF INDWELLING URINARY CATHETER ........ 20
1.07CATHERIZATION REMOVAL OF INDWELLING URINARY CATHETER .......... 25
1.08CATHERIZATION STRAIGHT CATHETER PROCEDURE ................................ 27
1.09DIABETIC TEACHING ........................................................................................... 32
1.10END STAGE DISEASE SERVICES ....................................................................... 35
1.11NEWBORN NURSING ASSESSMENT.................................................................. 44
1.12HOME NURSING OF THE POST-PARTUM MOTHER & INFANT ........................ 46
1.13HOSPITAL EVALUATION & DISCHARGE PLANNING ......................................... 49
1.14NURSING BAG MANAGEMENT............................................................................ 51
1.15NURSING SUPERVISORY VISIT .......................................................................... 54
1.16PH PROBE STUDY PLACEMENT & MONITORING .......................................... 55
1.17CHEST PHYSIOTHERAPY & POSTURAL DRAINAGE ........................................ 58
1.18BULB SUCTIONING .............................................................................................. 61
1.19NASOPHARAYNGEAL AND TRACHEAL SUCTIONING ...................................... 63
1.20THERMOREGULATION ........................................................................................ 66
1.21TRACHEOSTOMY CLEANING OF SUCTION CATHETERS & CONNECTING
TUBING......................................................................................................................... 71
1.22TRACHEOSTOMY STOMA SITE CARE ............................................................ 74
1.23TRACHEOSTOMY SUCTIONING.......................................................................... 76
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1.24TRACHEOSTOMY TIE CHANGE ....................................................................... 79

1.25TRACHEOSTOMY TUBE CHANGE ...................................................................... 82
1.26TRACHEOSTOMY TRANSITION TO HOME...................................................... 86
1.27URINE SPECIFIC GRAVITY MEASUREMENT ..................................................... 92
1.28WOUND CARE ASSESSMENT, CLASSIFICATION & STAGING ...................... 93
1.29WOUND CARE DRESSING CHANGES ............................................................. 96
SECTION II LABORATORY PROCEDURES........................................................... 102
2.01CENTRAL LINE CATHETER BLOOD DRAW ................................................... 103
2.02DORSAL VENIPUNCTURE PROCEDURE ......................................................... 108
2.03GLUCOSE TESTING USING GLUCOMETER.................................................. 110
2.04GLUCOSE TESTING USING TEST STRIPS .................................................... 113
2.05HEEL STICK PROCEDURE ................................................................................ 116
2.06IMPLANTED VASCULAR ACCESS DEVICE CATHETER BLOOD DRAW ...... 118
2.07PERIPHERAL BLOOD DRAW ............................................................................. 123
2.08PERIPHERALLY INSERTED CENTRAL CATHETHER BLOOD DRAW .......... 126
2.09SPUTUM CULTURE COLLECTION .................................................................... 131
2.10STOOL TESTING CULTURE & SENSITIVITY, OCCULT BLOOD, OVA &
PARASITES ................................................................................................................ 133
2.11TRACHEAL GASTRIC Ph & GASTRIC OCCULT BLOOD .................................. 137
2.12TRACHEAL ASPIRATE COLLECTION................................................................ 139
2.13URINE TESTING USE OF THE LABSTIX/MULTI-STIX SG REAGENT STRIPS
....141
SECTION III MEDICATION ADMINISTRATION ......................................................... 143
3.01Administration of Medications: General Guidelines .............................................. 144
3.02EYE DROP/OINTMENT ADMINISTRATION ....................................................... 147
3.03INHALED MEDICATION METERED DOSE INHALER (MDI) ........................... 149

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3.04INTRAMUSCULAR MEDICATION ADMINISTRATION ....................................... 151

3.05CEREDASE INJECTION (ALGLUCERASE) ........................................................ 155
3.06SYNAGIS ADMINISTRATION.............................................................................. 159
3.07ADMINISTRATION OF INTRAVENOUS ALBUMIN ............................................. 163
3.08ADMINISTRATION OF INTRAVENOUS AMPHOTERICIN B .............................. 167
3.09INTRAVENOUS ANTIBIOTICS (PIV) AND (VAD) USING A SYRINGE PUMP.... 172
3.10ARA-C ADMINISTRATION PROCEDURE (CYTOSINE ARABINOSIDE)
CYTOSAR, ARA-C, CYTARABINE ............................................................................. 175
3.11CHEMOTHERAPY ADMINISTRATION VIA LONG-TERM VASCULAR ACCESS
DEVICE....................................................................................................................... 178
3.12DEFEROXAMINE ADMINISTRATION ................................................................. 182
3.13FACTOR VIII ADMINISTRATION......................................................................... 186
3.14GANCICLOVIR (DHPG)....................................................................................... 189
3.15IV FLUSH GUIDELINES ...................................................................................... 193
3.16Heparin Grid A: Use to Complete Plan of Care (POC) ......................................... 194
3.17Heparin Grid B: Dose to be given........................................................................ 195
3.18ADMINISTRATION OF IV IMMUNE GLOBULINE ............................................... 196
3.19NASAL MEDICATION ADMINISTRATION .......................................................... 200
3.20DESMOPRESSION ACETATE (DDAVP) ADMINISTRATION ............................. 202
3.21ORAL MEDICATION ADMINISTRATION ............................................................ 204
3.22DIGOXIN (LANOXIN) ADMINISTRATION ........................................................... 208
3.22ADMINISTRATION OF MEDICATIONS INTO OUTER EAR CANAL................... 210
3.23RECTAL MEDICATION ADMINISTRATION ........................................................ 212
3.24SILVER NITRATE APPLICATION........................................................................ 214
3.25SUBCUTANEOUS MEDICATION ADMINISTRATION ........................................ 216
3.26EPOGEN (EPOETIN ALFA) ................................................................................. 219

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3.27GCSF (NEUPOGEN) (FILGRASTIM)................................................................... 223

3.28GROWTH HORMONE ADMINISTRATION.......................................................... 227
3.29INSULIN ADMINISTRATION USING SOFT POCKET TECHNIQUE ................ 230
3.30TOPICAL EMLA CREAM ADMINISTRATION...................................................... 234
3.31WYDASE (HYALURONIDASE) ADMINISTRATION ............................................ 236
SECTION IV HIGH TECH POLICIES.......................................................................... 238
4.01APNEA MONITOR ............................................................................................... 239
4.02ENTERAL INFUSION PUMPS FOR CONTINUOUS DRIP FEEDINGS............... 242
4.03INFUSION PUMPS .............................................................................................. 244
4.04MECHANICAL VENTILATION IN THE HOME ..................................................... 246
4.05AEROSOL THERAPY (NEBULIZER)................................................................... 249
4.06CARE & MAINTENANCE OF HAND-HELD NEBULIZER .................................... 252
4.07HOME OXYGEN THERAPY VIA NASAL CANNULA........................................... 254
4.08PHOTOTHERAPY................................................................................................ 258
4.09CENTRAL LINE CATHETER ADMINISTRATION OF IVP MEDICATION......... 261
4.10CENTRAL LINE CATHETER ADMINISTRATION OF IV HYDRATION FLUID . 264
4.11CENTRAL LINE CATHETER ADMINISTRATION OF TPN/IL........................... 267
4.12CENTRAL LINE CATHETER CAP CHANGE / ANTI-REFLUX VALVE................ 273
4.13CENTRAL LINE CATHETER DRESSING CHANGE ........................................ 275
4.14CENTRAL LINE CATHETER HEPARINIZATION ................................................ 278
4.15CENTRAL LINE CATHETER REPAIR - PERMANENT ....................................... 281
4.16CENTRAL LINE CATHETER REPAIR - TEMPORARY ....................................... 286
4.17CENTRAL LINE CATHETER SITE & LINE CULTURE ..................................... 290
4.18CENTRAL LINE CATHETER USE OF UROKINASE ........................................ 295
4.19EXTRAVASATION TREATMENT / DOCUMENTATION ................................... 299

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4.20IMPLANTED VASCULAR ACCESS DEVICE ADMINISTRATION OF IV

HYDRATION ............................................................................................................... 303
4.21IMPLANTED VASCULAR ACCESS DEVICE ADMINISTRATION OF IVP
MEDICATION.............................................................................................................. 306
4.22IMPLANTED VASCULAR ACCESS DEVICE ADMINISTRATION OF TRN/IL.. 309
4.23IMPLANTED VASCULAR ACCESS DEVICE CATHETER CARE &
MAINTENANCE .......................................................................................................... 315
4.24IMPLANTED VASCULAR ACCESS DEVICE - HEPARINIZATION ..................... 317
4.25IMPLANTED VASCULAR ACCESS DEVICE INSERTION OF HUBER NEEDLE
....321
4.26IMPLANTED VASCULAR ACCESS DEVICE REMOVAL OF HUBER NEEDLE
....326
4.27IMPLANTED VASCULAR ACCESS DEVICE SITE & LINE CULTURE ............ 329
4.28PERIPHERAL IV ACCESS & INSERTION........................................................ 335
4.29PERIPHERAL IV ADMINSITRATION OF IVP MEDICATION ........................... 339
4.30PERIPHERAL IV ADMINISTRATION OF IV HYDRATION ............................... 342
4.31PERIPHERAL IV - DISCONTINUATION.............................................................. 345
4.32PERIPHERAL IV - HEPARINIZATION ................................................................. 347
4.33PERITONEAL DIALYSIS CATHETER EXIT SITE CLEANING & DRESSING
CHANGE..................................................................................................................... 349
4.34PERITONEAL CATHETER EXIT SITE CULTURE............................................ 352
4.35PICC LINE ADMINISTRATION OF IVP MEDICATION ..................................... 354
4.36PICC LINE ADMINISTRATION OF HYDRATION ............................................. 357
4.37PICC LINE ADMINISTRATION OF TPN / IL ..................................................... 361
4.38PICC LINE CAP CHANGE / ANTI-REFLUX VALVE ......................................... 367
4.39PERIPHERALLY INSERTED CENTRAL CATHETER - DRESSING CHANGE ... 369
4.40PERIPHERALLY INSERTED CENTRAL CATHETER - HEPARINIZATION ........ 372
4.41INSERTION OF A PERIPHERALLY INSERTED CENTRAL CATHETER LINE

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(PICC / PIC) ................................................................................................................ 374

4.42PERIPHERALLY INSERTED CENTRAL CATHETER - REPAIR (TEMPORARY)
....380
4.43PERIPHERALLY INSERTED CENTRAL CATHETER REMOVAL.................... 383
4.44PERIPHERALLY INSERTED CENTRAL / MIDLINE CATHETER SITE & LINE
CULTURE ................................................................................................................... 385
4.45PERIPHERALLY INSERTED CENTRAL / MIDLINE CATHETER USE OF
UROKINACE............................................................................................................... 391
4.46GASTROSTOMY CARE ...................................................................................... 395
4.47GASTROSTOMY BUTTON REPLACEMENT ...................................................... 398
4.48REPLACEMENT OF GASTROSTOMY TUBE ..................................................... 400
4.49ADMINISTRATION OF TUBE FEEDING BOLUS, BAG METHOD USING
NASOGASTRIC TUBE, GASTORSTOMY TUBE, PERCUTANEOUS ENDOSCOPIC
GASTROSTOMY TUBE, OR JEJUNOSTOMY TUBE ................................................ 403
4.50ADMINISTRATION OF TUBE FEEDING BOLUS SYRINGE METHOD USING
NASOGASTRIC TUBE, GASTROSTOMY TUBE, PERCUTANEOUS ENDOSCOPIC
GASTROSTOMY TUBE, OR JEJUNOSTOMY TUBE ................................................ 405
4.51ADMINISTRATION OF MEDICATION THROUGH NASOGASTRIC,
GASTROSTOMY OR JEJUNOSTOMY FEEDING TUBE ........................................... 407
4.52ASSESSMENT OF GASTRIC RESIDUAL ........................................................... 409
4.53GAVAGE FEEDING: INTERMITTENT FEEDING VIA ORALLY / NASALLY
PLACED GAVAGE TUBE ........................................................................................... 411
4.54JEJUNOSTOMY CARE........................................................................................ 413
4.55PLACEMENT & VERIFICATION OF NASOGASTRIC FEEDING TUBE FOR
CONTINUOUS FEEDING PROCEDURE ................................................................... 417

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