PICU Procedures

By PICUlearn · Published 21 Sept 2026

Step-by-step walk-throughs of the procedures you will see and help with in paediatric intensive care, each paired with a video that shows it being done. For doctors, nurses, physiotherapists and advanced practitioners in any country. It explains what happens and how to help; it does not replace supervised practice or your unit's competency sign-off.

1. 1How to use this courseThis opening module explains who the PICU Procedures course is for, how each module is structured and how to get the most from the videos. It also sets out the safety habits and the supervised practice, simulation and local sign-off that turn understanding into competence.
2. 2Bag-mask ventilation and airway adjunctsThis module covers basic airway opening, mask ventilation with a self inflating or flow inflating bag, and the safe use of oropharyngeal and nasopharyngeal airways in infants and children. It sets out equipment, team roles, a step by step sequence, and how to recognise and fix the common problems of leak, obstruction and gastric inflation.
3. 3Tracheal intubation: the first intubatorThis module is written for the person holding the laryngoscope during tracheal intubation of a child in the PICU, from the decision to intubate through to confirming tube position and setting up ventilation. It gives particular attention to the failed first attempt: what to change, how to keep the child oxygenated between attempts, and when to declare a failed airway and call for rescue.
4. 4Assisting with intubationThis module is written for the person assisting at a paediatric intubation, usually the bedside nurse or an advanced care practitioner, and covers trolley preparation, drug and monitoring checks, the team brief, positioning, laryngeal manipulation on request, passing equipment and suction, monitor callouts, failed first attempt, tube securing and aftercare. It is deliberately shorter than the operator module because the focus is the assistant's role, not how to intubate.
5. 5Planned extubationPlanned extubation is the coordinated removal of an endotracheal tube once the child no longer needs invasive ventilation, with a clear plan for respiratory support afterwards. This module covers readiness assessment, preparation, team roles, the practical steps at the bedside and what to watch for in the hours that follow.
6. 6Endotracheal and tracheostomy suctioningThis module covers suctioning of an endotracheal tube or tracheostomy tube in a ventilated or spontaneously breathing child, including open and closed (in-line) systems, catheter choice, suction depth and the monitoring that must accompany every pass. It also sets out the roles of the bedside nurse, assistant and physiotherapist in safe, effective secretion clearance.
7. 7Emergency tracheostomy tube changeThis module covers the emergency management of a blocked or displaced tracheostomy tube in a child, including the bedside emergency box, recognition of trouble, and the principles of the widely used emergency algorithm. It also touches on routine tube changes and how families are taught to manage emergencies at home.
8. 8Chest drain insertion and careThis module explains why and how a chest drain is inserted in a critically ill child, and how the bedside team prepares, assists, monitors and cares for the drain afterwards. It covers site selection and the safe triangle in principle, the Seldinger and surgical approaches, drain systems, securing and imaging, complications and drain removal.
9. 9Setting up high flow and non-invasive ventilationThis module covers setting up high-flow nasal cannula therapy and non-invasive ventilation (CPAP and BiPAP) in the paediatric intensive care unit, from choosing and fitting the interface to starting, monitoring and weaning support. It also covers humidification, pressure injury prevention, gastric decompression and recognising when non-invasive support is failing.
10. 10Flexible bronchoscopy: the bedside team's roleThis module explains what the bedside team does before, during and after flexible bronchoscopy in PICU, from preparing the child and ventilator to monitoring, handling samples and recovery care. It describes the supporting role rather than how to perform the bronchoscopy itself.
11. 11Peripheral cannulation, including ultrasound guidanceThis module covers peripheral intravenous cannulation in children, from choosing a vein and cannula through comfort measures, safe holding, landmark technique and ultrasound guidance, to securing, flushing and checking for extravasation. It also sets out when to stop, escalate and consider an alternative route of access.
12. 12Intraosseous accessThis module covers intraosseous (IO) access in critically ill children: when to use it, which sites and landmarks to choose, how manual and powered needles are inserted and confirmed, and how to secure and monitor the site. It also covers what can be given through an IO needle, the complications to look for and how soon the needle should be replaced.
13. 13Central venous catheter insertionThis module walks through insertion of a central venous catheter in a critically ill child, covering site choice, the role of ultrasound, the insertion care bundle and the Seldinger technique step by step. It also covers confirming position, ongoing line care bundles to prevent infection, and the complications the bedside team must watch for.
14. 14Arterial line insertion and transducer set-upThis module covers arterial line insertion in children, from site selection and ultrasound or palpation technique to the steps of cannulation, and then the transducer set-up that turns a cannula into reliable monitoring. It also covers waveform interpretation, damping, safe sampling, line care and the limb checks that detect ischaemia early.
15. 15Defibrillation and synchronised cardioversionThis module explains when a shock is used to treat a child's rhythm, covering defibrillation for shockable cardiac arrest rhythms and synchronised cardioversion for unstable tachyarrhythmias with a pulse. It walks through pad choice and position, the safe charge and shock sequence, the purpose of synchronisation mode and what to do afterwards.
16. 16Lumbar punctureThis module covers diagnostic and therapeutic lumbar puncture in children, from deciding whether it is safe to proceed to positioning, landmarks, aseptic technique, sample handling and aftercare. It also explains when a lumbar puncture must be deferred and how the bedside team supports the child throughout.
17. 17Nasogastric tube placement and position checksThis module covers safe nasogastric tube placement in children, from choosing the right tube and measuring the insertion length to insertion technique, position confirmation and secure fixation. It explains why pH testing of aspirate and, when needed, a correctly interpreted X-ray are the only accepted checks, and why older bedside methods are unsafe.
18. 18Urinary catheterisationUrinary catheterisation in PICU allows accurate hourly urine measurement, relief of retention and aseptic urine sampling, but every catheter carries a risk of trauma and infection. This module covers indications, catheter choice, aseptic insertion in boys and girls, closed drainage, output measurement, catheter care and timely removal.
19. 19ECMO cannulation: what the bedside team doesThis awareness module explains what the bedside team does before, during and immediately after ECMO cannulation in a child, from preparing the bed space to the first checks once the circuit is running. It does not teach cannulation itself: that is done by a trained cannulating team with ECMO specialist and perfusion support.
20. 20Peritoneal dialysis catheter and starting PD: the bedside roleThis awareness module explains why peritoneal dialysis is often the gentlest form of kidney support for small children and infants after cardiac surgery, and what the bedside team does when a PD catheter is placed and dialysis is started. It covers preparation, circuit set up and priming per unit policy, fill, dwell and drain cycles, fluid balance recording and the complications the nurse at the bedside is best placed to spot.