Paediatric Vascular Disease

Details

Title

Paediatric Vascular Disease

Type

Stage Two

Module code

HPS185

Requirement

Compulsory

Module objective

By the end of this module, the Clinical Scientist in HSST will be able to apply their knowledge, skills and experience in the clinical setting to undertake a range of vascular investigations related to paediatrics. In the clinical setting this will include assessment of extra and intracranial cerebrovascular disease including screening and surveillance of paediatrics with sickle cell and thalassaemia disease. Clinical assessment will include scanning of upper and lower limb arterial and venous pathology, particularly related to arteriovenous malformation. They will be able to recognise, deliver and report the appropriate physiological test/s to address the findings from initial clinical assessment and apply a detailed knowledge of management options available to the supervising clinician. These will be based on the investigative findings and will allow the Clinical Scientist in HSST to critically evaluate their own response to both normal and complex situations using the professional attributes and insights required of a Clinical Scientist in HSST.

Knowledge and understanding

By the end of this module, the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the assessment, diagnosis and management of vascular disease in paediatric patients including: 

• governance issues related to the investigation of paediatrics including child. protection, safeguarding and consent.   

Sickle cell and thalassaemia scanning 

Current evidence and the clinical indications for the use of transcranial Doppler and carotid ultrasound scanning in sickle cell disease, including

• the pathophysiology of sickle cell anaemia (hemoglobin Hb SS and HbS ß zero thalassaemia) and its management.
• the evaluation of the outcome and clinical significance of clinical trials e.g. Stroke Prevention Trial in Sickle Anaemia (STOP1).
• typical anatomy and variants of intracranial anatomy.
• the extent of pathology including intra and extra cranial stenosis.
• normal and pathophysiological haemodynamics related to paediatrics and sickle cell disease including heart rate and Doppler sonograms.
• machine optimisation for obtaining diagnostic images and or Doppler sonograms including selection of appropriate imaging frequency.
• interpretation and reporting of images and Doppler recordings, related to patient management.
• safety issues associated with the use of transcranial Doppler in paediatrics, including thermal and mechanical indices, associated with heating and cavitation
• complementary use of MRA in the diagnosis and management of intracranial stenosis related to sickle cell disease.
• clinical networks associated with sickle cell and paediatric haematology disorders.

Arterial and venous malformation assessment

Current evidence and clinical presentation requiring the use of ultrasound in the assessment of arteriovenous malformation in paediatrics including;

• vascular malformations, including arterial, venous and arteriovenous. malformations, their distribution, prevalence, symptoms and treatment.
• imaging techniques and strategies, including selection of correct imaging and doppler frequencies related to the size of the child and position of the malformation.
• normal and pathophysiology haemodynamics related to children including heart rate, dppler waveform pulsatility and blood pressure.
• identification and differentiation of lesions using B-mode imaging, texture, lesion shape, size, borders and relationship with other structures.
• the limitations and potential souses of error involved with assessment of vascular malformations in children.
• the role of angiography, CT, contrast CT, MRI and MRA in the assessment of venous malformations in children and how these relate to ultrasound imaging.
• how to interpret CT and MR images.

Arterial and venous blood flow assessment of upper and lower limb arteries and veins

Current clinical indications for the use of Doppler ultrasound in the assessment of major arteries and veins in paediatrics including:

• the conditions requiring duplex assessment, including acute arterial ischaemic, venous thrombosis, trauma and sympathetic dystrophy.
• presenting signs and symptoms and how to identify possible alternative diagnosis.
• the identification of anatomy and variants.
• normal and pathophysiological haemodynamics related to paediatrics including heart rate, Doppler waveform shape and pulsatility and blood pressure.
• scanner optimisation for obtaining diagnostic images including selection of imaging and Doppler frequency related to the size of the child.
• the identification and grading of arterial or venous pathology, including peak velocities, velocity ratios, pulsatility and venous flow phasicity (high respiratory rate in paediatrics).
• the limitations and potential sources of error related to ultrasound scanning of arteries and veins in Paediatrics, especially related to peak systolic velocity and waveform pulsatility. Such limitations include scanning of paediatrics in ITU and the neonatal unit where ventilators and support equipment may be in use.
• the range of medical, interventional and surgical management options.
• the role of angiography, CT, MRI and MRA as alternative imaging techniques.

Technical and clinical skills

By the end of this module, the Clinical Scientist in HSST will be able to demonstrate a critical understanding of paediatric vascular ultrasound and its application to the performance and mastery of the following technical skills:

• Equipment set up, optimisation appropriate to paediatric applications.
• Transcranial Doppler assessment for sickle cell and thalassaemia disease.
• Paediatric carotid duplex assessment for sickle cell related stenoses or native stroke.
• Assessment of arterial and venous malformations including arteriovenous fistula.
• Arterial and venous duplex assessment of major arteries in paediatrics.
• Clinical evaluation of the degree of stenosis or extent of occlusions.
• Report writing.
• Data analysis.
• Data presentation related to MDT meetings and clinical reviews.
• Dissemination of findings, scientific data, with path of evidence leading to recommendation for future activity.
• Work with patients and parents to develop and update patient information materials appropriate to service requirements.

By the end of this module, the Clinical Scientist in HSST will be expected to critically reflect and apply in practice appropriate assessment techniques in a range of vascular conditions affecting paediatrics. They will have clinical and communication skills to advise and communicate effectively with patients, parents, careers, relevant clinicians and other healthcare professionals and will:

• educate clinicians and clinical vascular scientist with respect to the principle and procedure of a new technique and explain the interpretation of data or images acquired.
• take a clinical history and relate this to the clinical assessment of patient.
• choose and provide expert opinion on the most appropriate technique/test for the clinical presentation.
• perform the ultrasound imaging or physiological measurement diagnostic test, optimise equipment and acquire physiological images and measurements.
• analyse and interpret physiological images and measurements.
• formulate and organise data (clinical history, clinical assessment, scientific results) to accurately report cases and emphasise the key findings and diagnoses.
• compare all data to justify and validate the conclusion.
• communicate with the multi-disciplinary team and participate in MDTs especially related to sickle cell disease.
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations. The will also be expected to demonstrate the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence referring as appropriate to senior staff and will:

• remain open to new developments by attending conferences and reading journals.
• ensure clinical and scientist colleagues are kept up to date with new and novel techniques used within the service.
• ensure patients, parents and careers fully understand any procedure that is undertaken.
• continue to monitor any safety issues related to investigations and procedures.
• ensure that governance procedures are adhered to.
• perform audit to assess the effectiveness and accuracy of diagnostic procedures to help with management of patients’ health.
• perform audit to assess the patients, parents and carers’ experience of investigations or surveillance
• ensure patients, parents and careers fully understand any procedure that is undertaken.
• work in challenging environments such as paediatric ITU and neonatal units being empathetic and responding appropriately to the needs of the patient, parents and relatives.