Procedure Elective

Elective director:

Name: Shinpei Shibata

Email: shibata@ohsu.edu

Office: CDRC 1227

Phone: 503-494-9136

Elective duration:

2 weeks maximum (and preferred); 1 week possible in special circumstances

Overview:

The ACGME outlines that each pediatric resident must be able to competently perform certain essential procedure. Specifically, residents “must be able to competently perform procedures used by a pediatrician in general practice, including being able to describe the steps in the procedure, indications, contraindications, complications, pain management, post-procedure care, and interpretation of applicable results.”

Elective goals and objectives:

The goal of this elective is to provide additional dedicated time to understand indications for basic procedures and to perform these procedures with appropriate guidance and supervision. The procedural experience during this elective is based on ACGME competence guidelines. During this elective, residents should complete at least one procedure of the following:

    • Bladder catheterization

    • Giving immunization

    • Lumbar puncture

    • Temporary splinting of a fracture

    • Venipuncture

    • Bag-mask ventilation

    • Pediatric endotracheal intubation

Additional procedural experience possible during this elective based on resident schedule and patient availability:

    • Bone marrow biopsy

    • Reduction of simple dislocation

    • Simple laceration repair

    • Removal of foreign body

    • Incision and drainage of abscess

Resident Expectations:

    1. On time appearance for clinical duties

    2. Review of applicable videos and articles prior to performing any procedures

    3. Notification of chiefs, rotation director, and appropriate clinical parties for the day if you are sick

    4. Proper documentation of procedure within EPIC, as applicable

Schedule:

Prior to the start of the rotation:

    • Residents will receive a schedule for the two weeks prior to starting. This will have contact information for each clinical area, including where and when to meet each team

The first day of the rotation:

    • Meetup with your team for the day based on schedule made prior to the start of the rotation

    • Have pager on and available in case there are last minute changes

    • Contact elective director or chiefs if any questions

Overview of approximate time spent with each clinical opportunity

18 half days

Anesthesia x 4

Hem/onc x 2

IV therapy x2 - if going to be absent, page the charge nurse to let them know at 11771.

ED x4

Clinic and immunizations x 2

Splinting x 2

Reading/videos x2

2 half days continuity clinic

Optional activities:

    • Recertification for BLS, NRP, and/or PALS

    • Certification for ATLS

Resident Resources: Residents MUST view appropriate video prior to completing any procedure.

Lumbar Puncture: A complete review and demonstration of the procedure for lumbar puncture, including patient positioning, locating the puncture site, and puncture technique.

Bladder Catheterization: A complete review and demonstration of the procedure for bladder catheterization, including equipment setup, catheter insertion for male and female patients, and urine collection.

Giving Immunizations: A complete review and demonstration of the procedure for giving immunizations, including complete demonstrations of the techniques for giving intramuscular and subcutaneous injections.

Incision and drainage: A complete review and demonstration of the procedure for incision and drainage of abscess, including wound anesthetization, incision technique, blunt dissection, and insertion of packing materials.

Simple Laceration Repair: A complete review and demonstration of the procedure for simple laceration repair, including wound irrigation and exploration, tissue debridement, and closure technique.

Foreign Body Removal: A complete review and demonstration of the procedure for simple removal of foreign body, including demonstrations of removal of splinters, fishhooks, and foreign bodies from the ear and nose.

Temporary Splinting: A complete review and demonstration of the procedure for temporary splinting of fracture, including splint preparation, splint placement, and extremity immobilization

Reduction of simple dislocations: A complete review and demonstration of the procedure for reduction of simple dislocation, including full demonstrations of the procedures for reducing shoulder and patella dislocations.

PIV Starts: A complete review and demonstration of the procedure for peripheral intravenous catheter placement, including vein selection, needle insertion, catheter securement, and blood draw.

Venipuncture: A complete review and demonstration of the procedure for venipuncture, including vein selection, needle insertion, and blood draw.​

Bag valve mask ventilation: A complete review and demonstration of the procedure for bag-mask ventilation, including proper bag-mask placement, ventilation technique, and placement of an oropharyngeal airway.

Pediatric and Neonatal Intubation: A complete review and demonstration of the procedure for neonatal endotracheal intubation, including laryngoscope technique, endotracheal tube placement, and bag-mask attachment.

Other things