Procedural Ultrasound In Pediatric Patients: Techniques And Tips For Accuracy And Safety
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Procedural Ultrasound In Pediatric Patients: Techniques And Tips For Accuracy And Safety
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Publication Date: June 2016 (Volume 13, Number 6)

CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category 1 credits, 4 AAP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.

Author:
 
Sophia Lin, MD, RDMS
Assistant Professor of Pediatrics and Emergency Medicine, Director of Emergency Ultrasound, Weill Cornell Medical College, New York, NY
 
Peer Reviewers:
 
Rebecca Burton, MD
Attending Physician, Pediatric Emergency Medicine, Children’s Hospital at Montefiore, Bronx, NY
 
Aaron E Kornblith, MD
Assistant Clinical Professor, Department of Emergency Medicine & Pediatrics, University of California, San Francisco, San Francisco, CA

Abstract

Point-of-care ultrasound is becoming more prevalent in pediatric emergency departments as a critical adjunct to both diagnosis and procedure guidance. It is cost-effective, safe for unstable patients, and easily repeatable as a patient's clinical status changes. Point-of-care ultrasound does not expose the patient to ionizing radiation and may obviate the need for procedural sedation. Because the use of point-of-care ultrasound in pediatric emergency medicine is relatively new, the body of literature evaluating its utility is small, but grow­ing. Data from adult emergency medicine, radiology, critical care, and anesthesia evaluating the utility of ultrasound guidance must be extrapolated to pediatric emergency medicine. This issue will review the adult literature and the available pediatric literature comparing ultrasound guidance to more traditional approaches. Methods for using ultrasound guidance to perform various procedures, and the pitfalls associated with each procedure, will also be described.

Excerpt From This Issue

Bedside ultrasound, or point-of-care ultrasound (POCUS), is a critical adjunct to both diagnosis and procedure guidance, and its use is becoming more common in pediatric emergency departments (EDs).1,2 POCUS was first introduced to the ED more than 20 years ago. It is now widely used in adult emergency medicine, with abundant literature supporting its use. In 2001, the Accreditation Council for Graduate Medical Education mandated that emergency medicine residencies train residents in bedside ultrasound. Although less ubiquitous in the pediatric ED, its use and the pediatric emergency medicine literature supporting its use are rapidly increasing. More than 90% of pediatric emergency medicine fellowships now use bedside ultrasound.3 As of 2013, training in POCUS is an American Board of Pediatrics requirement for pediatric emergency medicine fellowship programs.4 In addition, consensus educational guidelines and a model curriculum have been published.5 The need for training and a curriculum in pediatric emergency medicine ultrasonography has been endorsed not only by the American Board of Pediatrics, but also by the American Academy of Pediatrics, Society of Academic Emergency Medicine, American College of Emergency Physicians, and the World Interactive Network Focused on Critical Ultrasound.6

Ultrasound is an ideal imaging modality in children for many reasons. Obtaining optimal ultrasound images in pediatric patients is easier because children are generally thinner and smaller than adults. POCUS is performed at the bedside and can be repeated as needed as a patient’s clinical condition changes. This portability adds a safety factor to POCUS, as potentially unstable patients do not need to go to the radiology suite for a formal radiological study. In addition, unlike computed tomography (CT) and magnetic resonance imaging, bedside ultrasound allows caregivers and staff members from child life to remain with patients throughout the examination, which may obviate the need for sedation. Most importantly, ultrasound does not expose a child to any ionizing radiation.

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Last Modified: 12/17/2018
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