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出版者:

作者:Ball, Jane W./ Bindler, Ruth Mcgillis W./ Cowen, Kay

出品人:

页数:1776

译者:

出版时间:2009-3

价格:$ 143.51

装帧:

isbn号码:9780135153819

丛书系列:

图书标签:

• 儿科护理
• 儿童健康
• 新生儿护理
• 儿科疾病
• 护理学
• 儿科
• 健康教育
• 母婴健康
• 临床护理
• 预防保健

Advanced Clinical Procedures in Pediatric Medicine: A Comprehensive Guide Introduction to the Scope and Philosophy This text, Advanced Clinical Procedures in Pediatric Medicine: A Comprehensive Guide, serves as an indispensable resource for healthcare professionals—physicians, advanced practice nurses, residents, and specialized pediatric technologists—who manage complex and high-acuity care scenarios within the pediatric population. Unlike foundational texts focusing on routine wellness checks or standard care protocols, this volume dives deep into the technical execution, physiological rationale, and critical decision-making required for intricate, invasive, and life-sustaining interventions across all pediatric age groups, from neonates through adolescence. The underlying philosophy of this guide is centered on evidence-based practice coupled with procedural mastery. It acknowledges the inherent challenges in performing advanced interventions on children: the rapid physiological changes based on size and maturity, the necessity of meticulous pain and anxiety management tailored to developmental stages, and the heightened need for clear communication with highly stressed family units. Therefore, each chapter is structured not merely as a procedural checklist but as a holistic guide incorporating pre-procedure assessment, sterile technique refinement, intra-procedural monitoring specific to pediatric compromise, and comprehensive post-procedure recovery management. Section I: Advanced Airway and Respiratory Management This foundational section moves beyond basic intubation techniques to address critical, often emergent, airway management scenarios unique to pediatric critical care. High-Frequency Oscillatory Ventilation (HFOV) Optimization in Neonatal Respiratory Distress Syndrome (NRDS): This chapter details the titration of mean airway pressure (MAP), the interpretation of lung mechanics derived from HFOV waveforms, and strategies for managing recruitment/derecruitment phenomena in fragile neonatal lungs. Specific protocols for navigating air leaks, such as pneumothorax management during HFOV, are provided with high-resolution diagrams illustrating chest tube insertion techniques optimized for infant anatomy. Surgical Airway Establishment and Management: A detailed comparative analysis of cricothyrotomy versus tracheostomy placement in pediatric emergencies. Emphasis is placed on appropriate instrument selection for varying pediatric weights, the physiological consequences of an emergent surgical airway, and the subsequent management of tracheostomy tubes, including suctioning protocols that minimize mucosal trauma and the nuances of tracheostomy weaning in older children with underlying neuromuscular conditions. Bronchoscopy in Pediatric Pulmonology: Beyond diagnostic visualization, this segment focuses on therapeutic bronchoscopy—foreign body removal in toddlers, management of refractory atelectasis using segmental lavage techniques, and the application of endobronchial stenting in congenital airway anomalies. Detailed procedural checklists emphasizing safety margins around the pediatric tracheobronchial tree are included. Section II: Complex Vascular Access and Hemodynamic Support Managing circulatory support in children requires precision, as small intravascular volumes are easily disrupted. This section covers vascular access beyond routine peripheral lines and central venous catheters (CVCs). Percutaneous Central Venous Access in Infants and Toddlers: Detailed anatomical landmarks for ultrasound-guided placement in suprascapular, internal jugular, and common femoral veins are analyzed, specifically addressing the reduced subcutaneous tissue and variable vessel diameter in neonates. Protocols for troubleshooting catheter tip malposition using fluoroscopy and managing catheter-related bloodstream infections (CRBSIs) in immunocompromised pediatric oncology patients are covered in depth. Arterial Line Placement and Continuous Monitoring: This chapter focuses on interpreting invasive hemodynamic waveforms in shock states (e.g., septic shock vs. cardiogenic shock in pediatric cardiomyopathy). It includes advanced techniques for monitoring mixed venous oxygen saturation ($ ext{SvO}_2$) via specialized catheters and managing vasopressor infusions requiring precise titration based on dynamic parameters like stroke volume variation (SVV). Extracorporeal Membrane Oxygenation (ECMO) Cannulation Protocols: This advanced section details the surgical and percutaneous cannulation approaches for Veno-Arterial (VA) and Veno-Venous (VV) ECMO in pediatric patients. It dissects the complexity of systemic anticoagulation management (Heparin protocols, goal Anti-Xa monitoring) tailored to the age-specific coagulation cascade deficiencies present in pediatric respiratory or cardiac failure. Section III: Neurological Interventions and Monitoring Caring for the injured or critically ill pediatric brain demands specialized monitoring techniques to prevent secondary injury. Intracranial Pressure (ICP) Monitoring and Management: This covers the indications and technical implementation of various ICP monitoring modalities, including bolt placement versus fiberoptic catheter insertion in pediatric hydrocephalus or traumatic brain injury. Critical sections address the interpretation of ICP waveforms (e.g., Lundberg waves) and aggressive management strategies, such as hyperosmolar therapy (mannitol vs. hypertonic saline titration) and controlled hypothermia protocols adapted for the developing brain. Cerebrospinal Fluid (CSF) Management: Detailed protocols for external ventricular drain (EVD) placement and maintenance, focusing on preventing infection in infants with large ventricles. The chapter also discusses therapeutic CSF diversion techniques for intractable intracranial hypertension when standard medical management fails. Pediatric Lumbar Puncture Variations: Advanced considerations for lumbar puncture in the setting of suspected meningitis when mass effect is present, including CT-before-LP algorithms, and protocols for obtaining deep intrathecal drug administration (e.g., chemotherapy) safely. Section IV: Gastrointestinal and Renal Critical Procedures This section addresses emergent needs related to abdominal catastrophe and fluid/electrolyte management in high-risk pediatric populations. Acute Abdominal Decompression and Lavage: Techniques for managing severe intra-abdominal hypertension (IAH) in pediatric burn victims or those with necrotizing enterocolitis (NEC). This includes guidelines for temporary abdominal wall closure using synthetic mesh systems and the management of resulting short bowel syndrome sequelae. Continuous Renal Replacement Therapy (CRRT) Setup and Titration: Focusing on CRRT initiation in pediatric acute kidney injury (AKI), particularly in the context of sepsis or post-cardiac surgery. It provides detailed schematics for various circuit configurations (e.g., slow continuous ultrafiltration, SCUF) and precise protocols for balancing fluid removal rates against maintaining stable electrolyte levels ($ ext{K}^+$, $ ext{Ca}^{2+}$, $ ext{PO}_4^{3-}$), which are highly sensitive in small bodies. Enteral Tube Management and Feeding Optimization: Beyond simple placement, this covers complex algorithms for managing feeding intolerance in ventilated patients, including dual-lumen feeding tubes for gastric decompression while maintaining post-pyloric enteral delivery, and the meticulous calculation of specialized parenteral nutrition (PN) formulations for patients with metabolic derangements. Section V: Specialized Support and Procedural Safety The final section consolidates overarching principles essential for complex pediatric care delivery. Pediatric Organ and Tissue Procurement Procedures: Detailed ethical and procedural guidelines for managing the deceased or dying pediatric patient undergoing organ donation, ensuring dignity and adherence to strict protocols required when managing the transition from intensive care to surgical procurement teams. Advanced Sedation and Analgesia in Procedural Settings: A deep dive into pharmacokinetics and pharmacodynamics of anesthetic agents (e.g., propofol, ketamine, dexmedetomidine) in pediatric patients with underlying organ dysfunction (hepatic failure, renal impairment). This emphasizes goal-directed sedation tailored to developmental expectations (e.g., RASS scoring in adolescents versus comfort scales in infants). Radiation Safety and Imaging Guidance in Interventional Pediatrics: Protocols for minimizing radiation exposure during fluoroscopically guided procedures (e.g., pacemaker placement, angiography) using dose reduction technologies, shielded barriers, and precise time/dose monitoring specific to the cumulative lifetime radiation exposure of children. This guide is meticulously curated to serve as the definitive reference for practitioners navigating the most demanding clinical challenges in pediatric medicine, emphasizing technical excellence and evidence-based decision-making under pressure.

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