Procedures Under Sedation (Specialist Clinics)
Pre-Referral Guidelines

Initial Work-up

Suggested non-sedative techniques to be tried prior to referral:

• Use of topical anaesthetic
• Distraction tools & techniques  
• A paediatric specialist phlebotomy service

When to refer

• If all non-sedative alternative options have been explored
• Community management has not adequately addressed the child/ family goals
• There is no closer public hospital with paediatric services that the child is known too
• The referrer has completed an initial medical assessment including details required for referral
• The referral criteria below have been met
  
  

RCH Eligibility Criteria:  

• Age range - > 2 years – < 18 years 
• Reason for referral includes at least one of the following:  
      - Increased anxiety associated with regular blood tests / injections 
      - Previous traumatic and/or unsuccessful attempts despite adjunct support 
      - Neurodevelopmental Disorder(s) predisposing to procedure-related trauma

RCH Exclusion Criteria:  

• Chronic respiratory problems including OSA 
• Abnormal airway/jaw 
• Significant cardiac impairment
   
  

Referral Information must include:

• Reason for sedation
• Test(s) required – (please include pathology slips for all tests requested) 
• Previous medical history including:
      - Underlying diagnosis
      - Weight
      - Baseline observations (HR & blood pressure)
      - Allergies
      - Current medication
      - Details of previous venipuncture attempts
      - Details of previous sedation attempts      

The additional information form to be included with the RCH referral to Specialist Clinics can be found here

RCH Specialist clinic Referral form (pdf)

Resources

These resources can help children and families to understand what to expect when coming to the hospital for a procedure under sedation.  

• Be Positive Video’s - A Child’s Guide:  www.rch.org.au/be-positive 
  Including a video on what to expect when having sedation via a mask:  
  www.rch.org.au/be-positive/A_childs_guide_to_hospital/Nitrous_oxide/ 

• Kids Health information – Parent information fact sheets & videos

Kids Health Information: Reducing your child's discomfort during procedures

• RCH Comfort Kids -www.rch.org.au/comfortkids/for_parents/ 
  This website provides a toolkit to help prepare your child for tests and procedures.

Additional web-based resources developed specifically to empower children and families with pain management strategies, skills, and support.  

• Meg Foundation (www.megfoundationforpain.org) 
• ImaginAction (ImaginAction (stanford.edu) 

References and more reading

ANZCA PG09(G) Guideline on procedural sedation 2022 

ISupport - International collaborative rights-based standards to Support Paediatric Patients during clinical Procedures by Reducing harm and establishing Trust.

Owner: Specialist Clinic Nurse Unit Manager

• Guideline first published - July 2023
• Guideline next review date - July 2025