Transcranial Doppler – How to successfully perform an optimal TCD on our younger patient demographic (ages 2-5 years)
Purpose or Case Report: Transcranial Doppler examinations are crucial in the care and treatment of patients in the Sickle cell population. The earlier we are able to obtain diagnostic studies on these patients the more effective treatment is and can reduce the risk of the patient suffering from a life altering stroke. Methods & Materials: This procedure while not invasive can be very frightening for a younger patient. We employ several different techniques and distractions tools to help the patient cope soundly through the exam. We work closely with the Hematology department staff and have developed a TCD task force specifically focused for this age group to increase our success rate. Some of the strategies we employ are as follows: arranging the ultrasound room so that the patient is able to view the television to watch a favorite show or program, letting the child play games on smart phones or tablets (without too much patient movement), having a parent or guardian lying with or holding the patient, sitting the patient up slightly, blowing bubbles, singing, having hand held musical or light up toys available and/or arranging to have a child life specialist present for the duration of the exam to help distract the patient. We have also produced a short informational video for new patients to view prior to coming to their first TCD exam so they can see what to expect. Results: By having several options in place and available, by planning ahead and having resilient, dedicated sonographers we are able to successfully perform TCDs on younger and younger patients thereby facilitating more positive outcomes for this patient population. Conclusions: Transcranial Doppler ultrasound is a low cost, easy to perform with dedicated practice, portable, radiation-free modality that with set parameters in place can be extremely successful in imaging younger patients. This exam gives immediate, important information to the Hematologist that will improve long term outcomes in the Sickle cell population.
( Children's Hospital of Philadelphia
, United States