Point-of-Care Ultrasound in Pediatric Clinical Care

McLario, David J.; Sivitz, Adam

doi:10.1001/jamapediatrics.2015.22

Cited by 52 publications

(48 citation statements)

References 76 publications

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“…Training is even more limited in pediatric residencies, as only 12.1% reported a formal curriculum, and 27.3% reported no US training at all. Point‐of‐care US has additional benefits in the pediatric population, given the importance of avoiding ionizing radiation . In addition, the smaller body size of children facilitates improved accessibility of structures for visualization and allows for superior image resolution with the use of higher‐frequency transducers …”

Section: Discussionmentioning

confidence: 99%

Prevalence and Scope of Point‐of‐Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine‐Pediatric Residency Programs in the United States

Reaume

Siuba

Wagner

et al. 2018

J of Ultrasound Medicine

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Objectives The purpose of this study was to determine the prevalence and scope of point‐of‐care ultrasound (US) education in internal medicine, pediatric, and medicine‐pediatric residency programs nationwide. Methods Program directors were surveyed between January and June 2016 with a 15‐item online questionnaire to assess the state of point‐of‐care US training in their programs. The survey aimed to identify whether programs had an established point‐of‐care US curriculum and, if not, what reasons may have existed for a lack of point‐of‐care US training in their programs. Results The survey was distributed to 685 program directors, and the response rate was 19.2%. Only 31.5% of respondents reported having a formal point‐of‐care US curriculum in their program, and in 12.4% of programs, there was no US training at all. The presence of point‐of‐care US training as reported by internal medicine (n = 64) and medicine‐pediatric (n = 24) respondents showed formal point‐of‐care US curriculum rates of 37.5% and 43.5%, respectively. Pediatric programs (n = 24) reported limited point‐of‐care US training, with formal curriculum in only 12.4% of programs and 27.3% having no point‐of‐care US training at all. The most common reasons for lack of a point‐of‐care US curriculum among program directors were lack of trained faculty/instructors (70.4%), lack of guidelines/standards by governing societies (44.4%), and lack of the necessary technology (33.3%). Conclusions Less than half of residents with internal medicine training will have trained at a program with a point‐of‐care US curriculum, and point‐of‐care US training in pediatrics is even more limited. The major reason for the lack of point‐of‐care US education is a lack of trained faculty or instructors.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Scope of Point‐of‐Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine‐Pediatric Residency Programs in the United States

Reaume

Siuba

Wagner

et al. 2018

J of Ultrasound Medicine

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“…Pediatric evidence-based US protocols and training methods are limited compared to the adult literature. [15][16][17][18][19] Depending on the availability of sonographers or radiologists at a center, this protocol could also be used instead of calling for a radiograph after PICC line placement. Our protocol may also be well suited to bedside US examinations performed by neonatal providers.…”

Section: Discussionmentioning

confidence: 99%

Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit

Motz

Arnim

Likes³

et al. 2018

J of Ultrasound Medicine

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Objectives To assess whether a limited ultrasound (US) scanning protocol to monitor the upper extremity peripherally inserted central catheter (PICC) location in neonates is feasible for experienced US operators. Methods A radiologist, who was blinded to the PICC location on chest radiography, performed 14 US scans on 11 neonates with upper extremity PICCs. A US machine with 13–6‐MHz linear and 8–4‐MHz phased array transducers was used for the examinations. Results The study population included 54% (n = 6) preterm infants, with 72% (n = 8) weighing less than 1500 g. The US location of the PICC was the same as the chest radiographic report in all 14 scans. A subclavicular long‐axis view of the anterior chest visualized all PICCs in the subclavian or brachiocephalic veins. A parasternal long‐axis right ventricular inflow view was able to visualize PICCs in the superior vena cava (SVC), and a subcostal long‐axis view evaluated PICCs in the lower SVC and heart. The scanning time was location dependent: less than 5 minutes for PICCs in the brachiocephalic or subclavian vein and 5 to 10 minutes for PICCs in the SVC or heart. There were no desaturations below 90%, increases in the fraction of inspired oxygen need, or hypotension episodes during scanning. Conclusions A limited US scanning protocol to determine the upper extremity PICC location is feasible. Our protocol needs to be tested in neonatal providers before further dissemination.

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“…7,12,23 Although considered an advanced application of ultrasonography, it is likely that peripheral nerve blocks will become more widely used because pediatric emergency providers gain proficiency in basic skills and point-of-care ultrasound equipment becomes more widely available. 32,33 …”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Femoral Nerve Blocks

Baker

Gullett

2015

Pediatric Emergency Care

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Pediatric acute femur fractures are a relatively common major orthopedic injury seen in emergency departments. Providing adequate and safe analgesia is essential while patients await definitive management of these fractures. Opioid medications are typically used to treat fracture-associated pain but have well-known adverse effects including respiratory and central nervous system depression, pruritus, nausea, and allergic reactions. Dose titration of opioids in pediatric patients may be difficult and requires frequent nursing and physician reassessments. Regional anesthesia using ultrasound guidance has been proposed as a reliable and safe method to provide pain relief for this population and to decrease reliance on opioid medications. There is a growing body of literature on the utility and safety of ultrasound-guided femoral nerve blocks for pediatric patients in the acute care setting. This review article covers recent literature on point-of-care ultrasound-guided femoral nerve blocks for pediatric patients, with a discussion of the indications, sonographic anatomy, selection of anesthetics, nerve block technique, and complications. This review supplements the expert supervision and practice required to gain competency.

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Point-of-Care Ultrasound in Pediatric Clinical Care

Cited by 52 publications

References 76 publications

Prevalence and Scope of Point‐of‐Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine‐Pediatric Residency Programs in the United States

Prevalence and Scope of Point‐of‐Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine‐Pediatric Residency Programs in the United States

Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit

Ultrasound-Guided Femoral Nerve Blocks

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