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:
On time appearance for clinical duties
Review of applicable videos and articles prior to performing any procedures
Notification of chiefs, rotation director, and appropriate clinical parties for the day if you are sick
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
Bone marrow biopsy: https://www.nejm.org/doi/full/10.1056/NEJMvcm0804634
Otoscopy and Cerumen Removal: https://www.nejm.org/doi/full/10.1056/NEJMvcm0904397
Intraosseous catheter placement in children: https://www.nejm.org/doi/full/10.1056/NEJMvcm0900916
Procedural Sedation and Analgesia in children: https://www.nejm.org/doi/full/10.1056/NEJMvcm1108559
Neonatal circumcision: https://www.nejm.org/doi/full/10.1056/NEJMvcm0810449
Managing procedural anxiety: https://www.nejm.org/doi/full/10.1056/NEJMvcm1411127
Placing an arterial line: https://www.nejm.org/doi/full/10.1056/NEJMvcm044149
Chest tube insertion: https://www.nejm.org/doi/full/10.1056/NEJMvcm071974