Paediatric Fluoroscopy It s a Small World Robyn Crapp Nurse Unit Manager Medical Imaging CHW
The most requested studies in our paediatric fluoroscopy are: MCU Contrast Meal
MCU
MCU s are requested when children have: Febrile UTI s Indications on ultrasound that renal reflux may be present such as: - dilated renal systems - hydro nephrosis - suspected post urethral valves
Performing the MCU Beforehand Ensure the patient has received antibiotic cover the day of and prior to the MCU if antibiotic not given, the MCU is rescheduled Ensure the procedure has been explained to the parents and consent obtained, either verbally or written Ensure the patient is changed into a hospital gown
Performing the MCU Use Aseptic Technique and catheterise with a small feeding tube: 5 French Gauge if < 3 months old 6 French Gauge if > 3 months old Ensure the catheter is secured with Micropore and attached to a giving set of contrast
Performing the MCU Start with KUB image to reveal if there are renal calculi present Cone on the bladder on filling, observe for uretrocele when the bladder is 1/3 full When the bladder is full Left and Right oblique views, looking for reflux If reflux is present, image the kidneys and ureter
Some notes on the MCU Urethral images for boys = voiding with catheter in and catheter out (post urethral valves) If the child is <1 year old, we do 2 fills Whether the images are held or exposed is up to the Consultant Radiologist The contrast used is Ultravist 370 diluted with N/S
250mL bag N/S blood giving set 100mLs N/S drained out 50mLs Ultravist 370 injected into the bag
Top Tips for a Successful MCU Keep the patient straight and still Gently hold the hands back keeping the shoulders straight - hold the legs straight at the knees Use warm water to pour over the perineum to encourage babies to void
Positioning and Restraining Patients Hold the knees
Catheterisation Boys: use a 2mL syringe filled with Lignocaine gel to open a tight foreskin and see the meatus Girls: legs in a frog position, feet together knees apart and hold the thighs, open both labia to see the urethra
Grade 4 Renal Reflux Grade 5 Renal Reflux
Grades 1-4 renal reflux
Contrast Meal
Contrast Meals are requested when children have suspected: Malrotation Gastric emptying Reflux Hiatus hernia
Swallows and Meals: Contrast Dilutions < 3 months Omnipaque 300 diluted 50/50 with sterile water > 3 months Omnipaque 300 diluted 50mLs contrast to 20mLs water Contrast Enema: - Omnipaque 300 diluted 50/50 with sterile water
Performing the Contrast Meal Ensure the procedure has been explained to the parents and consent obtained, either verbally or written Patients lie on fluoroscopy table and drink diluted contrast oesophagus is visualised on lateral and AP views When stomach is full, turn patient onto Right side
Performing the Contrast Meal With patient on Right side, image the C loop Turn the patient AP Ensure the patient is very straight, and that the bottom of the heart and the diaphragm are in the image Image the DJ Flexure if the DJ flexure positioning is inconclusive, a follow through to caecum could be considered
Top tips for a Successful Contrast Meal It is vital that the DJ flexure is captured with the patient flat and straight so there is not a false negative/positive reported
Positioning and Restraining Patients Hold the shoulders
Positioning and Restraining Patients For the upper GI Bring arms over head behind ears
Malrotation Normal DJ Flexure
Paediatric Considerations It is not just the child you are treating, but the parents and family that accompany them Caregivers will be frightened and worried, and will show these emotions in different ways
Paediatric Considerations Children are very different patients to adults We have a range of ages, sizes, and 5 different observation charts Our patients are 28 weeks to adolescents
Observation Ranges for Paediatric Patients Age Approx weight (kgs) Resp. Rate Heart Rate Syst. BP <3 months 3.5 30-55 110-160 60-100 3-12 months 3.5-10 30-45 100-160 70-110 1-4 years 10-16 20-40 90-140 90-110 5-11 years 20-32 20-30 80-120 90-110 12 and over 40+ 15-20 60-100 90-120
There is a small window of co operation with children it is best not to put the patient on the table until everything is ready: Have all the paper work handy and completed Have all necessary equipment set up and ready to go Ensure everyone has their lead coats on Hands washed/scrubbed, gloves on Then position the patient and begin
Age appropriate distraction techniques For babies and infants talking/singing softly Toddlers having their favourite toy Primary school age talking about favourite things sport, family, books, movies Teens don't talk at all Ipad/Iphone seems to work for all ages
A quick test is a good test