How We Do It

The Nasal Bridle: A Loop Retention Device

The use of nasogastric and nasojejunal feeding tubes have become important approaches to providing adequate calories and hydration for children, older adults, and others who have temporary or long-term need for alternate pathways for nutrition. Tube feeding can be an excellent option for any patient with a functional gastrointestinal tract, thereby avoiding intravenous hyperalimentation and its associated complications. Nasogastric and NJ feeding tubes are especially useful for nutritional supplementation for short-to-medium periods of time (< 6 weeks) because they reduce the need for more invasive and expensive procedures, including surgical, endoscopic, or percutaneous gastrostomy or gastrojejunostomy.

Peripherally Inserted Central Catheter Placement (PICC)

Complex central venous access has been a mainstay of the pediatric interventionalist’s practice since the 1970s. Although the upper arm is the most common entry site, any peripheral vein may be utilized if the diameter is large enough and if the vein is in continuity with central veins and the right atrium.

Treatment of a pseudoaneurysm

A PsA can occur in any artery in the body. The clinical presentation of a PsA is usually a tender, pulsatile mass in the region of an artery. There is often associated redness, pain with palpation and warmth of the skin. If there is the suspicion of a PsA, confirmation by US with Doppler examination is indicated.

Localizing small pulmonary nodules for resection

There seems to be increasing interest by caregivers and patients to rapidly diagnose the etiology of small pulmonary nodules (e.g., suspected metastases, fungal infiltrates or PTLD). Lesions > 1 cm and those abutting or near to the pleural surface are usually amenable to transthoracic image-guided core or fine needle aspiration biopsy.

Approach to local anesthesia in children

A minor pain at the beginning of a procedure can upset the child, making completion of the procedure more difficult. The best way to minimize the intensity of a painful stimulus is to provide suitable skin and track anesthesia to the level of the target anatomy.

Ultrasound diagnosis of midgut volvulus

An 11-month-old boy presented to the emergency department with non-bloody, non-bilious emesis. The patient was diagnosed with gastroenteritis and sent home.