Pediatric Interventional Studies PDF

Pediatric Interventional ​Studies Understanding the role of the Sonographer What are Interventional Procedures? An interventional procedure is a type of procedure performed by an Interventional Radiologist ( a special type of Doctor- Radiologist who can read diagnostic imaging AND perform p...

Pediatric Interventional ​Studies Understanding the role of the Sonographer What are Interventional Procedures? An interventional procedure is a type of procedure performed by an Interventional Radiologist ( a special type of Doctor- Radiologist who can read diagnostic imaging AND perform procedures) The role of the sonographer is to perform ultrasound guidance for the procedure The IR Doctor will request ultrasound needle guidance to ensure that access/ placement is correct. Probe and Set up Most pediatric and neonate scanning uses a high frequency transducer. If a 15 MHz linear array transducer is available, use this. If not, a 9 MHz linear transducer should be used. Turn OFF tissue harmonics. This will make the echogenic needle tip easier to visualize as contrast will be bistable. Set Up Prior to the interventional procedure being performed, the sonographer should read the requisition. Once arriving in the Interventional radiology surgical suite or patient room, confirm biopsy or access site location. Set up your machine OPPOSITE of the performing physician. This will give you room to work and will give the Doctor room to perform the exam. Prior to the nurse cleaning the patient, do a quick scan to confirm location of mass/ access. A nurse will prepare the patient and drape the sterile field accordingly. A sterile probe cover must be used for all interventional access. Sterile Probe Cover Needle Guidance Most of the needles used for interventional procedures are specifically made for ultrasound guidance. They are specially coated to be ECHOGENIC under ultrasound. Reverberation or "comet-tail" artifacts can be seen with needles. o Chiba class needles-safe, flexible, small (22G) o PICC lines (peripherally inserted central catheters)- Useful for safe central access for short-to-medium term use and are placed in central VEINS- subclavian vein, brachial vein) o Hickman or Broviac-tunneled catheter o Swann-Ganz- Pulmonary Artery Catheter Venous Access Sites Ultrasound on the pediatric patient will be used to locate a specific vein (determined by the Doctor) for placement of a PICC line or other type of venous catheter. The most frequently used central veins are the IJV, Subclavian vein, and Femoral Vein. Venous Access Sites Cont'd Venous access sites in the upper body include: o Subclavian Vein o Brachial Veins o Acessory Cephalic Vein o External Jugular Vein o Median Cubital Vein o Axillary Vein o Basilic Vein o Cephalic Vein o Median Vein Common Complications Associated with Venous Access Arterial Puncture Infection Catheter tip thrombosis Thrombophlebitis Fibrin sheath formation Air embolism Catheter fragment embolism Catheter malposition Pneumothorax Arrhythmias Biopsies Ultrasound guidance can be used to biopsy a mass These can be within an organ specifically, or of soft tissue location Most common type of biopsy on the neonate is soft tissue mass Complications arising from biopsies include: o Bleeding from the biopsy site o Post biopsy hematoma Complications Causes of DVT (deep vein thrombosis) in children: Microdamage to a vein can be caused by a central venous line or catheter. This causes platelets and clotting factors to form a clot within the vessel lumen. Clot may also be visualized within the lumen of the catheter. Ultrasound to confirm Complications Causes of pseudoaneurysms in children: Inflammation Trauma Iatrogenic- surgery, biopsies, drainage A pseudoaneurysm is a sac that forms off of the vessel wall of an artery. The arterial blood "pools" into this sac and creates a false vessel.