Pediatric Interventional Procedures Quiz

Pediatric Interventional Studies

• Pediatric and neonatal scanning often uses a 15 MHz linear array transducer; if unavailable, use a 9 MHz linear transducer.
• Turn off tissue harmonics to better visualize the echogenic needle tip during contrast procedures.
• Sonographer should review the requisition prior to the procedure.
• Confirm biopsy or access site location once in the interventional radiology suite or patient room.
• Position the ultrasound machine opposite the physician performing the procedure to provide ample working space.
• Pre-scan the patient to confirm mass or access location before the nurse cleans the patient for the procedure.
• A sterile probe cover is required for all interventional procedures.

Interventional Procedures

• Interventional procedures are performed by an Interventional Radiologist (IR).
• The IR is a type of doctor who reads diagnostic imaging and performs procedures.
• A Sonographer's role is to provide ultrasound guidance during the procedure.
• IR doctors request ultrasound guidance for needle placement for accuracy.

Needle Guidance

• Interventional needles are specifically designed for ultrasound guidance and are often coated to be highly echogenic.
• Reverberation or “comet-tail” artifacts may be evident with the use of needles.
• Various needle types, such as Chiba needles (small, flexible, safe), are commonly used.
• PICC lines (peripherally inserted central catheters) are used for temporary central venous access (e.g., subclavian or brachial veins).
• Other catheter types include Hickman or Broviac tunneled catheters, and Swan-Ganz pulmonary artery catheters.

Venous Access Sites

• Ultrasound guides venous access, locating the specific vein for the procedure.
• The most common central veins for access are the internal jugular vein (IJV), subclavian vein, and femoral vein.
• Additional venous access sites in the upper body include the subclavian vein, brachial veins, accessory cephalic vein, external jugular vein. median cubital vein, axillary vein, basilic vein, cephalic vein, and median vein.

Common Complications Associated with Venous Access

• Complications associated with venous access include arterial puncture, catheter tip thrombosis, fibrin sheath formation, catheter fragment embolism, pneumothorax, arrhythmias, infection, thrombophlebitis, air embolism, and catheter malpositioning.

Biopsies

• Ultrasound guidance can be used for mass biopsies within specific organs or soft tissue locations.
• Common biopsies in neonates involve soft tissue masses.
• Potential complications from biopsies include bleeding and post-biopsy hematoma.

Complications—Deep Vein Thrombosis (DVT)

• Deep vein thrombosis (DVT) in children can be caused by microdamage to a vein from a central venous line or catheter leading to clot formation within the affected vessel lumen.
• Ultrasounds can confirm the presence of DVT.

Complications—Pseudoaneurysms

• Pseudoaneurysms can arise from inflammation, trauma, or iatrogenic factors (like surgery or biopsies/drainage).
• Pseudoaneurysms manifest as a sac formation off the vessel wall. Arterial blood pooling within the sac creates a false vessel.