What are paediatric interventions?
PIR refers to image-guided minimally invasive treatments for a wide variety of illness in children, including cancer, internal bleeding, sepsis and trauma .These procedures usually mean that children can avoid undergoing conventional open surgery.
PIR care is often delivered by a specialised team of healthcare professionals, including paediatric interventional radiologists, radiographers and nurses. They have an intimate working knowledge of complex and rare paediatric conditions, most of which do not occur in adults. They understand how to adjust procedures according to a young child’s body tolerance, and how to minimize radiation exposure to children who are far more susceptible to radiation effects than adults.
How does the procedure work?
Similar to adult IR, PIR treatments offer shorter operating times, reduce infection risks, and shorten recovery time. This translates to a less distressing patient and carer experience, allowing parents to take less time off work and children less time off school. Because of the small pin-hole used, the scarring is minimal. Many adult IR procedures can be performed in children with some adapations in equipment and techniques.
Below are some of the PIR treatments which can be performed in children, more information of these procedures can be found in respective patient information pages:
1. Children with cancer
Biopsy: Under image guidance, tumour tissue can be sampled a small needle.
Embolization of tumours: High-dose chemotherapy or radiation therapy can be delivered to the tumour locally without exposing the rest of the body to the toxic effect.
Ablation: Through a small pinhole, different kinds of energy can be used to destroy tumour.
2. Children with sepsis
Drainage and aspiration: Open surgery can be avoided in deep seated infections.
3. Children with internal bleeding or trauma
Embolization for bleeding and embolization for trauma: Bleeding vessels can be plugged using metallic coils, medical glue or other materials. This allows a more precise and quicker way to stop the bleeding compared to open surgery.
4. Children with limb-threatening blood clots in the veins
Venous recanalization: With a small plastic tube, high local dose of medications for dissolving blood clots or mechanical suction can be applied to remove blood clots in the deep venous system.
5. Children requiring long term nutrition or medications
Venous access ports: Small devices can be implanted beneath the skin to deliver intravenous nutrition or medications
Enteric access (gastrostomy and gastrojejunostomy): Small devices can be placed to provide direct access to stomach in children who have difficulty to be fed orally
The above list is not exhaustive and many other adult IR treatments can be adapted to children.
What are the special concerns when performing IR treatment in children?
“Children are not just small adults” – this old adage remains true in the field of interventional radiology. Children often have diseases which are not often seen in adults. Sedation or general anaesthesia often have to be used in children to minimise patient stress and motions. Specialist PIR practitioners often need to “child-size” the IR procedure – this includes the technique, device, radiation exposure, fluid and contrast (dye) administration, in order to ensure the success and safety of the procedure.
Some diseases that are more commonly seen in children include vascular tumours and malformations (Please refer to CIRSE information sheet on “vascular malformation”, “embolization for arteriovenous malformation” and “sclerotherapy” for more information). These conditions often require input from different specialities and should be managed in specialist centres.
Many PIR treaments require sedation or general anaesthesia, because the patient needs to lie very still throughout the procedure and it can take a while. It is important that the child does not eat or drink anything for a few hours before the anaesthetic. This is called ‘fasting’ or ‘nil by mouth’. Fasting reduces the risk of stomach contents entering the lungs during and after the procedure. The PIR team will contact you the exact time that your child should be fasted. It is important to keep giving your child food and drink until the “fasting time” to ensure that he or she is well-hydrated.
The amount of radiation from X-ray guided interventions is usually higher than for traditional radiography (e.g. chest X-ray), depending on the quality of the image needed, the child’s size, and the time needed to perform the procedure. Specialist PIR teams will ensure the minimum amount of radiation is delivered safely and accurately.