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García-Aroca MA, Fernández-de Miguel JM, Franceschi MAD, Fernández-Vaquero MA, Meléndez-Salinas DA, Piñero-Merino M, Álvarez-Avello JM. Inhalation anesthesia without any intravenous management for pediatric proton beam therapy. Paediatr Anaesth 2023; 33:946-954. [PMID: 37526245 DOI: 10.1111/pan.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Proton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols. METHODS We reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway. RESULTS Of the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non-serious adverse effects was 0.7% (Clopper-Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper-Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches. CONCLUSION Inhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.
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Affiliation(s)
- Miguel A García-Aroca
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | | | | | | | | | - María Piñero-Merino
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | - José M Álvarez-Avello
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
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Length of Bowel Rest Does Not Predict Gastrojejunostomy Tube-Associated Intussusception Recurrence. J Pediatr Gastroenterol Nutr 2023; 76:379-384. [PMID: 36728771 DOI: 10.1097/mpg.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES One potential treatment for gastrojejunostomy (GJ) tube-related intussusception is bowel rest, whereby the GJ tube is replaced with a gastrostomy tube. The aim of this study was to determine whether bowel rest length was associated with decreased risk of re-intussusception. METHODS Pediatric patients with GJ tube-related intussusceptions were identified during the study period of January 1, 2010 and August 1, 2021. Records were reviewed for demographics, symptoms, need for central access to initiate parenteral nutrition, and length of stay. Comparison was made between patients with intussusception recurrence within 30 days and those without. Those undergoing earlier replacement, defined as the first quartile of rest time, or 72 hours, were then compared to longer periods of bowel rest. RESULTS Forty-six intussusceptions were included, with a median age of 2.8 years (interquartile range, IQR: 1.4-4.1) and weight of 12 kg (IQR: 8.9-15.4). All patients diagnosed as outpatient (54.3%) required hospital admission and 9 of 46 (19.6%) required central access. There were 7 recurrences (15.2%). There was no difference in recurrence based on time of bowel rest (5 days in those without vs 6 days in those with, P = 0.30) nor a difference in recurrence with <72 hours of bowel rest compared to >72 hours (1/15, 6.7% vs 6/31, 19.3%). Patients undergoing earlier exchange had a shorter median length of hospital stay (3 vs 8.5 days, P = 0.003). CONCLUSION Length of bowel rest was not associated with recurrent GJ tube-related intussusceptions. If bowel rest is utilized, <72 hours may be sufficient to decrease length of hospital stay.
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Adjunctive techniques for percutaneous enteral access in children: a pictorial review. Pediatr Radiol 2023; 53:324-331. [PMID: 36104540 DOI: 10.1007/s00247-022-05473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/13/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Primary percutaneous gastrostomy and gastrojejunostomy tube placements are fundamental procedures performed in pediatric interventional radiology, with both antegrade and retrograde techniques described. In pediatric patients, however, challenges may arise due to smaller patient size and anatomical variations. Several adjunctive techniques may facilitate safe percutaneous access in the setting of a limited percutaneous gastric access window. These include the intra-procedural use of cone beam computed tomography (CT), percutaneous needle decompression in the setting of distended air-filled bowel interposed between the stomach and abdominal wall, post-pyloric balloon occlusion to facilitate gastric distension, ultrasound-guided gastric puncture, and intra-gastric contrast-enhanced ultrasound (ceUS) to define the relationship of the gastric wall and the anterior abdominal wall. Adjunctive techniques may increase successful primary percutaneous gastroenteric tube placement and may improve operator confidence in safe placement.
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Routine Elective Gastrojejunostomy Tube Changes Are Associated With Reduced Tube Complications and Radiation Exposure. J Pediatr Gastroenterol Nutr 2023; 76:80-83. [PMID: 36122381 DOI: 10.1097/mpg.0000000000003615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gastrojejunostomy tubes (GJTs) can be a long-term solution for patients with intragastric feeding intolerance. Our retrospective study of 101 patients correlates the frequency of routine and urgent GJT changes, as well as complications and radiation exposure. Over a 2.75-year median duration, 60%, 33%, and 28% of patients had >1 episodes of a tube dislodgement/malpositioning, blockage, or leakage, respectively. Aspiration pneumonia hospital admission was required for 23% of patients. Patients with <1 routine tube change/year had more urgent changes/year (3.0) compared to patients with 1-2 (1.2) or >2 (0.8) routine yearly change. These patients required more frequent sedation for tube placement (21% vs 4.7%, P = 0.03) and experienced greater annual radiation exposure (9599 vs 304.5 and 69.1 μGym 2 , P = 0.01 and 0.008, respectively). Overall, aiming for a routine tube change at least every 6-12 months is associated with fewer urgent changes and complications as well as reduced radiation exposure and sedation requirements.
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Antibiotic prophylaxis for percutaneous endoscopic gastrostomy in pediatric patients: a meta-analysis. Pediatr Surg Int 2022; 39:63. [PMID: 36574093 DOI: 10.1007/s00383-022-05355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate if Antibiotic Prophylaxis (AP) can prevent wound and/or systemic infection in pediatric patients who underwent Percutaneous Endoscopic Gastrostomy (PEG). METHODS PubMed, Embase, and Cochrane databases were searched for Randomized Controlled Trials (RCT) and Observational Studies that compared AP vs. no Intervention (NI) in children submitted to PEG. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with random-effect models. Quality assessment and risk of bias were performed as outlined by Cochrane recommendations. RESULTS Four studies, including one RCT, with a total of 568 patients were included, in which 230 (40.5%) individuals received AP. The use of AP during PEG reduced the incidence of systemic infection (OR 0.46; 95% CI 0.24-0.90; p = 0.02; I2 = 0). However, no statistical difference was found for wound infection (OR 0.85; 95% CI 0.43-1.69; p = 0.64; I2 = 12%) and for the composite outcome of any kind of infection (OR 0.74; 95% CI 0.13-4.06; p = 0.73; I2 = 67%). CONCLUSION In this pooled analysis of 568 infants who underwent PEG, the use of AP reduced the incidence of systemic infection. Our results were compatible with findings obtained in the adult population. No differences were found regarding wound infection or the composite outcome of any kind of infection.
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Parra J, Jeyakumar A, Chick JFB, Smith CA, Bertino FJ, Monroe EJ. Retrograde Placement of Ring-Bolster Retained Tubes Facilitates Gastrostomy to Gastrojejunostomy Revision in Children with Esophageal Pathology and Microgastria. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1740574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractTechniques for gastrostomy revision to gastrojejunostomy within the pediatric population, who have failed initial tube placement due to obstructive pathologies, have not been well established. Novel techniques are required to improve outcomes for these patients, and these techniques must be evaluated for both viability and safety. This article describes a technique utilized for gastrostomy to gastrojejunostomy revision and the outcomes for three pediatric patients.
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Affiliation(s)
- Jorge Parra
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, Washington, United States
| | - Arthie Jeyakumar
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington, United States
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington, United States
- Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington, United States
| | - Caitlin A. Smith
- Department of Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington, United States
| | - Frederic J. Bertino
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington, United States
| | - Eric J. Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington, United States
- Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington, United States
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Khattab M, Howard B, Al-Rifai S, Torgerson T, Vassar M. Adherence to the RIGHT statement in Society of Interventional Radiology guidelines. J Osteopath Med 2021; 121:11-24. [DOI: 10.1515/jom-2020-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Context
The Reporting Items for Practice Guidelines in Health Care (RIGHT) Statement was developed by a multidisciplinary team of experts to improve reporting quality and transparency in clinical practice guideline development.
Objective
To assess the quality of reporting in clinical practice guidelines put forth by the Society of Interventional Radiology (SIR) and their adherence to the RIGHT statement checklist.
Methods
In March 2018, using the 22 criteria listed in the RIGHT statement, two researchers independently documented adherence to each item for all eligible guidelines listed by the SIR by reading through each guideline and using the RIGHT statement elaboration and explanation document as a guide to determine if each item was appropriately addressed as listed in the checklist. To qualify for inclusion in this study, each guideline must have met the strict definition for a clinical practice guideline as set forth by the National Institute of Health and the Institute of Medicine, meaning they were informed by a systematic review of evidence and intended to direct patient care and physician decisions. Guidelines were excluded if they were identified as consensus statements, position statements, reporting standards, and training standards or guidelines. After exclusion criteria were applied, the two researchers scored each of the remaining clinical practice guidelines (CPGs) using a prespecified abstraction Google form that reflected the RIGHT statement checklist (22 criteria; 35 items inclusive of subset questions). Each item on the abstraction form consisted of a “yes/no” option; each item on the RIGHT checklist was recorded as “yes” if it was included in the guideline and “no” if it was not. Each checklist item was weighed equally. Partial adherence to checklist items was recorded as “no.” Data were extracted into Microsoft Excel (Microsoft Corporation) for statistical analysis.
Results
The initial search results yielded 129 CPGs in the following areas: 13 of the guidelines were in the field of interventional oncology; 16 in neurovascular disorders; five in nonvascular interventions; four in pediatrics; 25 in peripheral, arterial, and aortic disease; one in cardiac; one in portal and mesenteric vascular disease; 37 in practice development and safety; three in spine and musculoskeletal disorders; 14 in venous disease; five in renal failure/hemodialysis; and five in women’s health. Of the 46 guidelines deemed eligible for evaluation by the RIGHT checklist, 12 of the checklist items showed less than 25% adherence and 13 showed more than 75% adherence. Of 35 individual RIGHT statement checklist items, adherence was found for a mean (SD) of 22.9 items (16.3). The median number of items with adherence was 21 (interquartile range, 7.5–38).
Conclusion
The quality of reporting in interventional radiology guidelines is lacking in several key areas, including whether patient preferences were considered, whether costs and resources were considered, the strength of the recommendations, and the certainty of the body of evidence. Poor adherence to the RIGHT statement checklist in these guidelines reveals many areas for improvement in guideline reporting.
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Affiliation(s)
- Mostafa Khattab
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Benjamin Howard
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Shafiq Al-Rifai
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
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Sethupathi S, Walter K, Lim M, Fang A. Retrospective Analysis of the Safety and Outcomes of Percutaneous Radiologic Gastrostomy in Obese vs Nonobese Patients. JPEN J Parenter Enteral Nutr 2021; 45:1714-1719. [PMID: 33433937 DOI: 10.1002/jpen.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study is to compare the safety and outcomes of percutaneous radiologic gastrostomy (PRG) in obese vs nonobese patients. METHODS This is an institutional review board-approved retrospective study of 109 patients (male:female, 68:41; mean age, 64.7 years; range, 21-94 years) who underwent PRG with or without gastropexy at a single academic medical center between 2015 and 2018. Body mass index (BMI) of ≥30 kg/m2 was defined as obese. Patient demographics, indications, technical success, intraoperative variables, and major/minor complications were analyzed. Major and minor complications occurring within 30 days of the procedure were recorded and categorized based on the Society of Interventional Radiology Quality Improvement guidelines. RESULTS Of 109 patients included in the study, 22.9% (n = 25) of patients were obese (average BMI, 34.6 kg/m2 ; range, 30-50). Overall technical success in the obese and nonobese groups was 100% each. In the obese vs nonobese group, major and minor complications were not significantly different. There were also no significant differences in procedure time, fluoroscopy time, or contrast volume. However, mean peak skin dose was significantly increased in the obese group vs nonobese group (190.3 ± 224.2 vs 59.1 ± 71.1 mGy; P < .0001). CONCLUSION PRG is a safe procedure in obese patients with similar technical success, major and minor complication rates, procedure time, fluoroscopy time, and contrast volume. However, PRG is associated with increased radiation dose with obese patients; therefore, optimal methods of radiation protection should be utilized.
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Affiliation(s)
| | - Kate Walter
- Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Maria Lim
- Saint Louis College of Pharmacy, St Louis, Missouri, USA
| | - Adam Fang
- the Department of Diagnostic Radiology and Nuclear Medicine, Division of Vascular and Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Durand R, Cahill AM, Shellikeri S, Acord M. Postpyloric Balloon Occlusion to Increase Technical Success during Pediatric Percutaneous Gastrostomy/Gastrojejunostomy Tube Placement. J Vasc Interv Radiol 2020; 31:1139-1142.e1. [PMID: 32534976 DOI: 10.1016/j.jvir.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022] Open
Abstract
Gastric distension through insufflation is a key step in creating a safe percutaneous window during gastrostomy/gastrojejunostomy (G/GJ) placement; however, poor or incomplete gastric distention can occur, despite the use of glucagon, and lead to rapid egress of air from the stomach into the duodenum. This report describes the adjunctive technique using postpyloric balloon occlusion in 29 patients to maximize gastric insufflation during G/GJ tube placement after failure of conventional methods. Balloon occlusion was successful in salvaging 23 of 29 (79.3%) of G/GJ tube placements without any complications.
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Affiliation(s)
- Rachelle Durand
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Anne Marie Cahill
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Sphoorti Shellikeri
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Michael Acord
- Division of Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
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Conversion to Gastrojejunostomy Tubes in Developmentally Disabled Children Intolerant to Gastrostomy Tube Feeding. J Pediatr Gastroenterol Nutr 2019; 69:e75-e78. [PMID: 31107798 DOI: 10.1097/mpg.0000000000002391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study retrospectively evaluated the safety, impact on growth, and clinical outcomes of gastrojejunostomy tubes (GJTs) converted from surgically placed gastrostomy tubes (GTs) in 44 developmentally disabled children (median age: 28 months). The total duration of GJT follow-up was 31,378 device-days (median: 643 device-days). Three major complications (aspiration pneumonia) were identified in 3 patients (6.8%), 63 minor complications in 31 patients (70.5%), and 202 tube maintenance issues (TMIs) in 41 patients (93.2%). A significantly increased average change in weight-for-age z-scores was observed at each 6-month interval that continued past 25 months. Patients above the median rate of TMIs had marginally significant lower z-scores across the study period (P = 0.06), compared with those below the median rate. GJTs were removed in 6 patients (13.6%) because of adequate oral intake at last follow-up. Conversion from GTs to GJTs was a viable option to achieve sustained growth in developmentally disabled children. Frequency of TMIs may negatively impact their growth.
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Patel PA, Minhas K, Ang J, Stuart S, De Coppi P, Gnannt R. Non-vascular interventional radiology in the paediatric alimentary tract. Eur J Radiol 2019; 112:72-81. [PMID: 30777223 DOI: 10.1016/j.ejrad.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022]
Abstract
Paediatric interventional radiology is an evolving speciality which is able to offer numerous minimally invasive treatments for gastrointestinal tract pathologies. Here we describe interventions performed by paediatric interventional radiologists on the alimentary tract from the mouth to the rectum. The interventions include sclerotherapy, stricture management by dilation, stenting and adjunctive therapies such as Mitomycin C administration and enteral access for feeding, motility assessment and administration of enemas.
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Affiliation(s)
- Premal A Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Kishore Minhas
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Jestine Ang
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Sam Stuart
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Ralph Gnannt
- Bilddiagnostik, Paediatric Interventional Radiology, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
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12
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Caldas ACS, Dias RS, Sousa SDMAD, Teixeira E. Creative and sensitive production of care-educational technology for families of children with gastrostomy. ESCOLA ANNA NERY 2019. [DOI: 10.1590/2177-9465-ean-2018-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To describe the production process of a care-educational technology for families of children with gastrostomy based on the models of Hildegard Peplau and Paulo Freire. Method: Descriptive and qualitative research, carried out from October 2016 to February 2017 in three health units and a residential unit in São Luís, MA, Brazil. Thirteen family members participated. Were used from the creative method sensitive to dynamic body knowledge, semi-structured interview and observation. Thematic analysis. Results: From the problem situations that emerged from the corpus, the contents of the technology were constructed, and decoding in subtopics. The technology is of the printed type (booklet), titled The child and his gastrostomy: a guide for families and caregivers. Contains 24 pages and nine content topics, with texts and images. Conclusion: Social evidence that favored the production of a technology that is sensitive to reality, which, after being validated, will help families emerged. Implications for practice: The booklet can be used in the teaching and assistance activities of the families.
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Affiliation(s)
| | | | | | - Elizabeth Teixeira
- Universidade do Estado do Amazonas, Brasil; Centro Universitário Luterano de Manaus, Brasil
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Gill AE, Gallagher N, McElhanon BO, Painter AR, Gold BD, Hawkins CM. Image-guided placement of percutaneous de novo low-profile gastrojejunostomy tubes in the pediatric population: a study of feasibility and efficacy. Pediatr Radiol 2018; 48:882-888. [PMID: 29423647 DOI: 10.1007/s00247-018-4082-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/08/2017] [Accepted: 01/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND De novo low-profile gastrojejunostomy tubes in pediatric patients offer less external catheter bulk and decreased propensity for dislodgement as children become more mobile. While small cohort studies have evaluated de novo placement of coaxial, adjustable-length, percutaneous gastrojejunostomy (GJ) tubes in children, placement of de novo low-profile GJ tubes in pediatric patients has not been analyzed. OBJECTIVE This study evaluates technical feasibility, safety and clinical efficacy of percutaneous, retrograde placement of de novo low-profile GJ tubes in infants and children. MATERIALS AND METHODS Following institutional review board approval, all de novo low-profile GJ tube placements in patients were retrospectively reviewed between May 2014 and May 2017. Technical parameters of fluoroscopy time, tube size, T-fasteners and complications were recorded. Clinical data, including age, indication, weight gain and complications, were analyzed. RESULTS Thirty-four de novo low-profile GJ tubes were placed in 34 patients (median age: 9.4 months, range: 2 months-11.8 years; median pre-procedural weight: 7.5 kg, range: 2.9-31.6 kg). Twenty-one 14-Fr and 13 16-Fr GJ tubes were placed with technical success rate of 100%. Average weight gain 3 months' post procedure was 1.1 kg (range: 0.3-4.8 kg) and average weight percentile for age increase was 9.6% (range: -48.9% to 53.5%). One major complication occurred following balloon inflation within the tract causing pain requiring urgent replacement of the GJ tube. Minor complications occurred in 11 patients (32%): accidental dislodgement (n=9), skin irritation (n=4), tube dysfunction (n=2), leakage (n=2) and tube migration into the esophagus (n=1). CONCLUSION Percutaneous, antegrade, image-guided placement of de novo low-profile GJ tubes is technically feasible, safe and clinically efficacious in appropriately selected pediatric patients.
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Affiliation(s)
- Anne E Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA. .,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA.
| | - Nicholas Gallagher
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Barbara O McElhanon
- Aerodigestive Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Gastroenterology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Amy R Painter
- Aerodigestive Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Benjamin D Gold
- Aerodigestive Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,GI Care for Kids, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA
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Dalla Vestra M, Grolla E, Bonanni L, Pesavento R. Are too many inferior vena cava filters used? Controversial evidences in different clinical settings: a narrative review. Intern Emerg Med 2018; 13:145-154. [PMID: 27873159 DOI: 10.1007/s11739-016-1575-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/12/2016] [Indexed: 10/20/2022]
Abstract
The use of inferior vena cava filters to prevent pulmonary embolism is increasing mainly because of indications that appear to be unclearly codified and recommended. The evidence supporting this approach is often heterogeneous, and mainly based on observational studies and consensus opinions, while the insertion of an IVC filter exposes patients to the risk of complications and increases health care costs. Thus, several proposed indications for an IVC filter placement remain controversial. We attempt to review the proof on the efficacy and safety of IVC filters in several "special" clinical settings, and assess the robustness of the available evidence for any specific indication to place an IVC filter.
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Affiliation(s)
- Michele Dalla Vestra
- Department of Internal Medicine, Angiology Unit, Ospedale dell'Angelo, Via Paccagnella 11, 30174, Mestre (VE), Italy.
| | | | - Luca Bonanni
- Department of Internal Medicine, Ospedale dell'Angelo, Mestre (VE), Italy
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Value of Antibiotic Prophylaxis for Percutaneous Gastrostomy: A Double-Blind Randomized Trial. J Vasc Interv Radiol 2018; 29:55-61.e2. [DOI: 10.1016/j.jvir.2017.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/19/2017] [Accepted: 08/20/2017] [Indexed: 11/20/2022] Open
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Haber ZM, Charles HW, Gross JS, Pflager D, Deipolyi AR. Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches. Diagn Interv Radiol 2017; 23:55-60. [PMID: 27911264 DOI: 10.5152/dir.2016.15626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE We aimed to compare the antegrade transoral and the retrograde transabdominal approaches for fluoroscopy-guided percutaneous gastrostomy tube (G-tube) placement. METHODS Following institutional review board approval, all G-tubes at two academic hospitals (January 2014 to May 2015) were reviewed retrospectively. Retrograde approach was used at Hospital 1 and both antegrade and retrograde approaches were used at Hospital 2. Chart review determined type of anesthesia used during placement, dose of radiation used, fluoroscopy time, procedure time, medical history, and complications. RESULTS A total of 149 patients (64 women, 85 men; mean age, 64.4±1.3 years) underwent G-tube placement, including 93 (62%) placed via the retrograde transabdominal approach and 56 (38%) placed via the antegrade transoral approach. Retrograde placement entailed fewer anesthesiology consultations (P < 0.001), less overall procedure time (P = 0.023), and less fluoroscopy time (P < 0.001). A comparison of approaches for placement within the same hospital demonstrated that the retrograde approach led to significantly reduced radiation dose (P = 0.022). There were no differences in minor complication rates (13%-19%; P = 0.430), or major complication rates (6%-7%; P = 0.871) between the two techniques. CONCLUSION G-tube placement using the retrograde transabdominal approach is associated with less fluoroscopy time, procedure time, radiation exposure, and need for anesthesiology consultation with similar safety profile compared with the antegrade transoral approach. Additionally, it is hypothesized that decreased procedure time and anesthesiology consultation using the transoral approach are likely associated with reduced cost.
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Affiliation(s)
- Zachary M Haber
- Division of Vascular and Interventional Radiology Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
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Peritonitis following percutaneous gastrostomy tube insertions in children. Pediatr Radiol 2016; 46:1444-50. [PMID: 27173980 DOI: 10.1007/s00247-016-3628-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/16/2016] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. OBJECTIVE To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. MATERIALS AND METHODS We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. RESULTS Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. CONCLUSION Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome. Patients with peritonitis are delayed starting feeds and have a hospital stay that is an average of 5 days longer than those without.
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Livingston MH, Pepe D, Jones S, Bütter A, Merritt NH. Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath. Can J Surg 2015. [PMID: 26204365 DOI: 10.1503/cjs.014814] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure. METHODS We identified infants, children and young adults who underwent laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a "push" technique with a tear-away sheath. RESULTS We included 92 patients in our study. Mean age was 3.7 years (range 3 wk-5 yr), and mean weight was 11.2 (range 2.8-54) kg. Median procedural time was 20 (range 12-76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures. CONCLUSION Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges.
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Affiliation(s)
- Michael H Livingston
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Daniel Pepe
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Sarah Jones
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Andreana Bütter
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Neil H Merritt
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
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