significantly reduced their use of this tool After explaining the procedure to the family, open the papoose across the ED stretcher Place the child supine on the papoose, and expose the body area necessary for treatment Beginning with the midabdominal restraints, cover the child across the midline with the Velcro-lined flaps ( Fig 130.1C ) Better exposure of the extremities, such as the hand, is obtained by flexion of the area under the harness ( Fig 130.1D ) Before starting a wound repair or other procedure, reassess for the safety and adequacy of immobilization of the child and correct it if necessary Again, leaving an arm/hand free for a parent or staff member to hold can aid in both comfort and distraction There is a small group of children with autism spectrum disorders (ASDs) that may find the papoose calming due to the containment and pressure The papoose may be offered to families with children with an ASD as a first line of restraint as opposed to manual restraint by staff EXTERNAL JUGULAR VENIPUNCTURE OR PERIPHERAL CANNULATION Indications Venous blood sampling or placement of a peripheral intravenous catheter when peripheral veins on the extremities are inadequate Complications Hematoma Infection Equipment Venous blood sampling: Butterfly (21 to 23 gauge); 5- to 10-mL syringe; povidone-iodine or chlorhexidine antiseptic solution; sterile gauze