Pediatric Imaging



Pediatric Imaging










THE PEDIATRIC PATIENT

Pediatric patients range in age from infancy to 15 years. Children in this broadly defined group require special care, depending on their age and ability to comprehend the radiographic imaging procedure(s). In order to be both sensitive and effective in performing the imaging procedure, radiographers must use age-appropriate methods of communication and execution of the required procedure according to a child’s age. Caring for infants and children demands special safety and effective communication techniques and approaches that are different from adult radiography. It also requires a sensitive approach toward the accompanying parent(s) or guardian(s) to develop a rapport. Display 7-1 outlines developmental approaches to be taken with children. In addition to imaging pediatric patients in the diagnostic imaging department, mobile procedures are performed on pediatric patients in the hospital room, emergency room, operating room, and neonatal intensive care nursery.

The pediatric patient includes neonates in neonatal intensive care unit (NICU), infants, toddlers, preschoolers, and school-age children. The immaturity of the neonatal immune system, in particular, dictates adherence of health care personnel to infection control practices. Infection control precautions are described in Chapter 5. Preventative measures to reduce infections in the pediatric patient begin with basic practices such as proper hand washing and hygiene to prevent the spread of infections.

Children of all ages respond in a positive manner to honesty and friendliness. A small child may be very frightened when entering the imaging department and seeing the rooms with massive equipment. If the radiographer spends a few moments establishing a rapport with the child and acquainting the child with the new environment, the procedure will proceed more smoothly in a nonthreatening manner, and the child will leave the department with a positive attitude about the imaging process.


Most children resist immediate close contact with strangers. Therefore, it is best to talk to the child from a comfortable distance and allow the child to become accustomed to one’s presence before approaching them. The technologist must explain what is going to happen before and during the procedure to the child who is old enough to understand. The technologist should also give the child an estimate of how long the procedure will last and what will be expected of him or her. In addition, the technologist must explain the procedure and the process to the parent or guardian. The child should be prepared for any discomfort that he or she may feel. If the child is to receive contrast media or medications, the method of administration needs to be explained to both the parent/guardian and the child. Explanations to children are most effective if they are brief, simple, and to the point. The child should not be given choices when it is not appropriate because it may be confusing (Display 7-2).

The radiographer should speak to the child at eye level even if one must sit or stoop down to do so. To avoid misunderstandings, only one person should explain and direct the child. It is important to explain the process to the parent or guardian and to ask for their assistance during the procedure when possible. Using a soft tone of voice with the child and speaking in terms that are simple and familiar will enhance communication and cooperation. The radiographer must be certain that the child understands what is being said. If the child wishes to carry a toy or security item to the imaging room, he or she should be allowed to do so if at all possible. If it is not practical, explain to the child that the toy will be placed so the child can see it during the procedure. Return the toy to the child immediately after the procedure.


When explaining a procedure to a child, specify what part of the body will be examined, why, and who will be performing the procedure. Also explain how the examination will proceed, what part of the child’s body must be touched to properly position the patient to accomplish the procedure, and why he or she must hold still during the process. When the parent/guardian is able to assist holding the child for positioning purposes, lead aprons and gloves must be provided for them. Before the procedure is started, the parent/guardian must give consent.

Some children are very modest. If a child’s body must be exposed for an examination, only the necessary part should be exposed. The technologist must guard against allowing the child to become chilled while in his care. This is particularly important for infants because they lose body heat rapidly and hypothermia may occur.

Parents or guardians who accompany the child must be given an explanation of the procedure. Enlist their cooperation by encouraging them to explain the child’s special needs and sensitivities. If possible, ask the parent/guardian to remain with the child during the procedure, unless they are pregnant, without jeopardizing the child’s safety or the successful completion of the procedure, and provide them with the appropriate protective apparel and other radiation protective measures. Also, give the parent or guardian specific instructions about what is expected of them during the procedure. It is important to follow the department policies and procedures addressing the parents’ or guardians’ role during the radiographic examinations.

Explicit instructions must be provided in all aspects for the adult involved in the procedure. The adult holding the child must ensure the child will not fall from the x-ray table. If the parent or guardian is holding the child during the imaging procedure, he or she must wear the proper protective apparel, which includes a lead apron and possibly lead gloves. In addition to explaining the importance of wearing the protective apparel, the technologist should explain how to secure the apron and assist them with the garments. Make sure that the child is not left unattended while this is being done. The radiographer must never assume that the parent is watching the child on an x-ray table and must instruct the parent/guardian about the exact measures they need to take. The following is an example of how this may be done.



RADIOGRAPHER: I would like you to stand on this side of the table with your hands on your child (use child’s name) at all times. It will be necessary for you to wear this lead apron while I am x-raying your child as a radiation protective measure. I will hold the child while you put on the apron. The apron fastens with Velcro attachments on the sides. Now, please keep your hands on the child at all times.

On occasion, if the child refuses to follow directions and is emotionally distraught, it may be necessary for the accompanying adult to leave the room. The parent/guardian must agree to leave the x-ray room. In this case, the child must be made to understand that the doctor and the parent/guardian want the examination to be done to help him or her get well and that the procedure will be completed as soon as possible. Then, repeat the directions and proceed. Do not belittle or criticize the child’s behavior; remain nonjudgmental and matter of fact and accomplish the task as quickly as possible. Display 7-2 summarizes the steps in caring for children during the imaging procedures.




The High-Risk Newborn Infant

Many hospitals have special care units for high-risk newborn infants. In many areas of the United States, infants are transported to such facilities for special care from the hospital in which they were born. Infants may be considered to be at high risk for life-threatening problems if they are of low birth weight or if they have other perinatal problems.

Infants whose lives are at risk require special care considerations in highly specialized NICUs. Here, they are protected from threats to their nutritional status, environmental problems such as changes in their body temperature, and infection by being placed in isolettes with environmental and thermal control and by the practice of meticulous infection control measures.

Infection prevention and control practices are the responsibility of all health care personnel, including the radiographer. The NICU patient, in particular, has an immature immune system and, therefore, is more susceptible to infection. The radiographer must follow and adhere to the pediatric unit’s standard precautions, policies, and procedures. Hand hygiene is the basic important practice that reduces the risk of infection transmission. A surgical scrub, or a 2-minute scrub as for medical asepsis, may be required of all health care personnel entering these nurseries. Personal protective equipment such as gowns, gloves, masks, and eye protection may be required. The technologist must have the proper education and training on pediatric standard precautions for the prevention of the transmission of infection. The prevention of infection includes cleaning the x-ray equipment, which includes the mobile x-ray machine, the image receptors or detectors, gonadal shielding, and right or left markers. The mobile machine must be wiped clean with a disinfectant solution and must be free of dust before entering the nursery. Specific procedures must be followed in regard to the imaging equipment and accessories.






FIGURE 7-1 Chest images of a newborn infant with tubes.

The nurse in charge of the infant’s care must be consulted. The nurse should be asked to assist by positioning and immobilizing the infant. Care must be taken to prevent chilling the infant or dislodging any catheters or tubing while performing the radiographic procedure (Fig. 7-1). The technologist should provide a protective apparel apron to the nurse who is assisting to hold the infant (Fig. 7-2); provide the infant with gonadal shielding when appropriate.

If the radiographer has any sort of respiratory infection or infected cuts on his hands, another technologist should be asked to take the NICU assignment to prevent introduction of infectious microorganisms into the protective environment of the NICU.

May 8, 2019 | Posted by in GENERAL RADIOLOGY | Comments Off on Pediatric Imaging

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