Diagnostic ultrasound ( PDFDrive )

CHAPTER
56
Pediatric Interventional Sonography
Neil Johnson and Allison Aguado
SUMMARY OF KEY POINTS
• Understanding of the different needs of the parents and
the child being treated is essential for pediatric
interventions.
• Multimodality interventional suites allow for procedural
guidance with varied modalities at different points during
the procedure.
• Although needle guides may be used, they add to the
expense of the procedure. Therefore we typically advocate
for a single-operator freehand technique with needle entry
point chosen after careful consideration of the anatomy
and important structures such as ribs, large vessels,
diaphragm, and bowel.
• Many needles and devices are available, and each
practitioner should select and become very familiar with a
limited selection of these devices.
• Few children younger than 12 years will cooperate during
an invasive procedure, and a thorough familiarity with
pediatric sedation is necessary, together with skilled
personnel and adequate resuscitation facilities.
• In general, it is the external covering of an organ or
muscle, the pleura, the peritoneum, the perimysium, or
the deep fascia that registers pain sensation. Therefore
local anesthesia is particularly important in these deep
areas.
• Procedures such as abscess drainage, peripherally inserted
central catheter (PICC) lines, pleural drainage,
percutaneous cholangiography, targeted organ lesion
biopsy, and musculoskeletal procedures can all beneit
from ultrasound guidance.
CHAPTER OUTLINE
GENERAL PRINCIPLES
The Patient
Personnel and Equipment
GUIDANCE METHODS
Multimodality Interventional Suites
ULTRASOUND TECHNIQUES
Equipment and Transducers
One Operator Versus Two
Freehand Versus Mechanical Guides
Color Doppler Ultrasound
FREEHAND TECHNIQUE
Initial Needle Placement and
Localization
Locating the Needle After Insertion
Correcting the Needle Angle
Correcting the Off-Target Needle
Training Aids for Freehand Sonographic
Intervention
NEEDLES, WIRES, CATHETERS, AND
BIOPSY DEVICES
Chiba Needles
Drainage Catheters
Initial Puncture Device
Biopsy Devices
ANATOMY
Diaphragm
Colon or Bowel
SEDATION
LOCAL ANESTHETIC TECHNIQUE
Ultrasound-Guided Deep Local
Anesthetic Administration
ANTIBIOTICS
THE TYPICAL PROCEDURE
Prior Consultation and Prior Studies
Coagulation Studies
Aims and Expectations
Initial Ultrasound Scan Should Occur
Before Sedation
Pus
Catheter Fixation May Be Dificult in
Infants
Postprocedure Care and Follow-Up
SPECIFIC PROCEDURES
Abscess Drainage
Transrectal Drainage
Peripherally Inserted Central Catheter
Lines
Central Venous Access
Pleural and Peritoneal Drainage
Percutaneous Cholangiography and
Drainage
Mediastinal Mass Biopsy
Appendiceal Abscess Drainage
Targeted Organ Lesion Biopsy
Musculoskeletal Procedures
Head and Neck Lesions
NOTE FROM THE AUTHORS
GENERAL PRINCIPLES
The Patient
Unlike many adult patients, most pediatric patients are medically
robust, without multiple comorbidities such as superimposed
coronary, peripheral vascular, or cerebral disease. he smaller
the patient, the more appropriate is the use of ultrasound for
interventional procedure guidance of at least the initial access
phase of an interventional procedure. Physicians whose practice
includes mostly adults oten regard a baby as a fragile, dangerous
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