An alternative approach utilizes hyperpronation with flexion to achieve reduction Some clinicians use this method as their primary means of reduction, whereas others employ it if the supination–flexion technique fails This approach may be less painful, although any discomfort during a successful reduction maneuver should be short lived As shown in Figure 130.50B , gently grasp the patient’s hand on the affected side as if to shake it, stabilize the elbow joint in some flexion, and place pressure with a finger on the radial head Gently distract the elbow joint and hyperpronate by rotating the hand on the affected side medially As before, a “pop” should be felt with the finger that overlies the radial head ACKNOWLEDGMENTS Jennifer L Green, MS, CCLS, BSN, RN—assisted with Preparation and Assessment of the Child and Positioning and Restraints Mary Frey, MSN, RN—assisted with Accessing Central Venous Catheters, Nasogastric Tube Placement, and Catheterization of the Bladder Suggested Readings and Key References Preparation and Assessment of the Child and Positioning and Restraints Committee on Hospital Care and Child Life Council Child life services Pediatrics 2014;133(5):e1471–e1478 Dingeman RS, Mitchell EA, Meyer EC, et al Parent presence during complex invasive procedures and cardiopulmonary resuscitation: a systematic review of the literature Pediatrics 2007;120(4):842–854 Eppich WJ, Arnold LD Family member presence in the pediatric emergency department Curr Opin Pediatr 2003;15(3):294–298 Farah MM, Thomas CA, Shaw KN Evidence-based guidelines for family presence in the resuscitation room: a step-by-step approach Pediatr Emerg Care 2007;23(8):587–591 Sacchetti A, Paston C, Carraccio C Family members not disrupt care when present during invasive procedures Acad Emerg Med 2005;12:477–479 Umbilical Artery Catheterization Barrington KJ Umbilical artery catheters in the newborn: effects of position of the catheter tip Cochrane Database Syst Rev 2000;(2):CD000505 Lumbar Puncture Amini A, Liu JK, Kan P, et al Cerebrospinal fluid dissecting into spinal epidural space after lumbar puncture causing cauda equina syndrome: review of