Despite global advancements in pediatric medicine, technologies which have become standard-of-care in high-resource settings are unavailable in low-and middle-income countries due to cost, availability, or challenges maintaining equipment. This book compiles evidence-based and expert clinical procedural adaptations in an approachable, case-based, step-by-step guide, aimed to provide educational support for healthcare providers practicing in resource-limited settings. This responds to both the high demand for this content and the importance of gathering experts across continents and pediatric disciplines.
Each chapter provides both a theoretical framework and practical discussion of high-yield procedural adaptations. Leading international researchers and seasoned clinicians with expertise using these adaptations were selected by the editors as authors. Chapters include an example case with adaptation use and detailed instructions including supplies, indications, risks, and benefits. Content is grounded in current best practice recommendations and evidence-based research.
Highlighted by the COVID-19 pandemic, a mature understanding of pathophysiology and device design/safety is required when providing care in low-resource settings or in crisis times. In-person instruction is not always feasible. Written and virtual platforms remain critical in disseminating high-yield, practical content. This book is not a substitute for appropriate procedural training, though is easily modified to meet the educational needs of diverse learner groups. It is a valuable resource for appropriately trained practitioners practicing in accordance with local guidelines.
Knowledge and fluency with pediatric procedural adaptations is critical in efforts to reduce global inequities and pediatric morbidity/mortality in low-resource settings.
Author(s): Tina M. Slusher, Ashley R. Bjorklund, Stephanie M. Lauden
Publisher: Springer
Year: 2022
Language: English
Pages: 320
City: Cham
Foreword
Acknowledgments
Contents
Editors and Contributors
About the Editors
Contributors
Background
References
Procedural Adaptation and Device Modification Concepts in a Low-Resource Setting
1 Background
2 Ethical Framework
3 Using This Book
References
Basics of Pediatric Intensive Care, Neonatal Intensive Care, and Pediatric Emergency Medicine in a Low-Resource Setting
1 Background
1.1 Administration
1.2 Levels of Care
1.3 Personnel
2 Physical Resources and Spaces
3 Essential Durable Medical Equipment and Disposable Medical Supplies
4 Essential Drugs
5 Essential Laboratory Tests
6 Clinical Care Protocols: Policies
7 Infection Control
8 Record Keeping
9 Evaluating Clinical Care
10 Training/Education
11 Challenges
References
Further Reading
Neonatal Resuscitation in Resource-Constrained Settings: Sustaining Helping Babies Breathe and Beyond in a Low-Resource Setting
1 Case Example
2 Introduction
3 The Helping Babies Breathe Program
4 The Helping Babies Breathe Action Plan (Second Edition)
5 Expanding Care Beyond HBB
5.1 Advanced Respiratory Monitoring and Support
5.2 Chest Compressions
5.3 Medications and Access
6 Equipment: Purchasing, Maintenance, and Reprocessing
6.1 Purchasing
6.2 Reprocessing
7 Conclusion
8 Case Resolution
References
Further Reading
Phototherapy in a Low-Resource Setting
1 Case Example
2 Introduction
3 Science of Phototherapy
3.1 Suggested Resources for Facilities Using Phototherapy
4 Indications
4.1 Contraindications
4.2 Technique
5 Light-Emitting Diodes
5.1 Equipment/Supply List for LED
6 Fluorescent Tube Units
6.1 Equipment/Supply List for Fluorescent Units
7 Filtered Sunlight Phototherapy (FSPT)
7.1 Equipment/Supply List for FSPT
7.2 Instructions for Use
7.2.1 Measuring Phototherapy
7.2.2 General Principle of Optimizing Phototherapy
7.2.3 Treatable Percentage of Body Surface Area (BSA)
7.2.4 Minimizing Distance Between Device and the Patient
7.2.5 Use of Reflectors
7.2.6 Surface Area of the Skin Exposed to Phototherapy
7.2.7 Duration of Treatment
7.3 Complications of Phototherapy
8 Case Resolution
References
Additional Resource
Umbilical Venous Catheter Placement in a Low-Resource Setting
1 Case Example 1
2 Case Example 2
3 Introduction
4 Challenges to Umbilical Catheterization in LMICs
5 UVC Indications/Uses/Benefits
6 UVC Contraindications
6.1 UVC Equipment/Supplies (Fig. 1)
7 UVC Procedural Technique
7.1 Initial Preparation
7.2 Sterile Preparation
7.3 Catheter Placement
7.4 Securing Catheter
7.5 Instructions for Use
7.5.1 Care of the UVC
7.5.2 Indications for UVC Removal
7.5.3 Procedure for Catheter Removal
7.6 Complications
8 Case Resolution 1
9 Case Resolution 2
References
Exchange Blood Transfusions for Severe Hyperbilirubinemia in Resource-Limited Settings
1 Case
2 Introduction
3 Indications for Exchange Blood Transfusion
4 Contraindications
5 Benefits
6 Steps to Set up
6.1 Procedure Supplies
6.2 Pre-procedure Preparations
6.3 Patient Preparation
6.4 Procedural Steps
6.5 Procedure
6.5.1 Determinants of EBT Effectiveness
6.5.2 Post-EBT Care
6.6 Follow-Up
7 Risks and Potential Complications
7.1 Additional Pearls
8 Case Summary
9 For Further Reading
References
Breastfeeding Support Devices in Low-Resource Settings
1 Case I Example
2 Introduction
3 Breastfeeding Basics
3.1 Procedure for Feeding the Well Newborn
3.1.1 Positioning
3.1.2 Methods for Latching
3.1.3 Assessing and Teaching Milk Transfer
3.1.4 Feeding Frequency and Cues
3.2 Common Breastfeeding Problems
3.2.1 Breastfeeding Tips and Pearls
3.3 Case I Resolution
3.4 Case Example 2
3.5 Building and Maintaining Milk Supply
3.5.1 Use of Galactogogues
4 Case 2 Resolution
5 Case 3
5.1 Creamatocrit
5.2 Measuring a Creamatocrit
5.3 Estimating Calories Based on Creamatocrit
5.4 Breast Milk Storage
6 Case 3 Resolution
6.1 Complications
6.2 Conclusion
References
Kangaroo Mother Care in a Low-Resource Setting
1 Case
2 Introduction
3 Indications
3.1 Contraindications and Relative Contradictions
4 Equipment/Supplies
5 Technique
5.1 Instructions for Support Device/Carrier [8]
5.1.1 Complications
5.1.2 Case Resolution
References
Safe Options for Obtaining Blood and Vascular Access in Neonates and Children in a Low-Resource Setting
1 Case Example
2 Introduction
3 Indications
4 Contraindications
5 Venipuncture
5.1 Equipment/Supplies
6 Technique
6.1 Emotional Support
6.2 Preparation for Venipuncture
6.3 Procedure for Venipuncture
7 Heel Puncture/“Heel Stick” Procedure for Neonates and Infants
7.1 Equipment/Supplies (Fig. 4a–c)
7.2 Technique
7.2.1 Preparation for Heel Prick
7.2.2 Heel Prick Procedure
7.3 Complications
7.3.1 Venipuncture
7.3.2 Heel Prick
7.4 Case Resolution
References
Pediatric Resuscitation Guidelines for Limited-Resource Settings
1 Case
2 Introduction
3 Case Continuation in Healthcare Settings with No Availability of Intensive Care
4 Case Management Discussion
4.1 Non-ICU Setting
4.2 Referral and Transport Considerations
4.3 Transport
5 Case Continuation in Healthcare Settings with Availability of Intensive Care
6 Case Discussion
6.1 ICU Setting
6.2 Medication Preparation/Dosing Chart
7 Summary
8 Case Resolution
9 For Further Reading
References
Oral Rehydration Therapy in a Low-Resource Setting
1 Case Example 1
2 Introduction
2.1 Oral Rehydration Salt Solution
2.2 ReSoMal
2.3 Ongoing Refinement of ORS
2.4 Cost of Not Using ORS
3 Indications
4 Contraindications
5 Equipment/Supplies
5.1 Homemade Salt-Sugar Solution
6 Technique
6.1 Homemade Recipe
7 Instructions for Use
7.1 Determine Level of Dehydration
7.2 Treatment Plan A and B
8 Case 1 Resolution
9 Case Example 2
9.1 Treatment Plan C
10 Complications
11 Conclusion
12 Case 2 Resolution
13 For Further Reading
References
Malnutrition: Practical Approaches to Feeding a Severely Malnourished Child in a Low-Resource Setting
1 Case Example
2 Introduction
2.1 Indications for Inpatient Re-feeding
3 Contraindications
4 Equipment
4.1 Stabilization Phase: Therapeutic Milk: F75/F100
4.2 Rehabilitation Phase
4.2.1 Complimentary and Transition Foods
4.2.2 Other Situations: Children Younger Than 6 Months
5 Technique/Goals
6 Instructions for Use
6.1 Discharge from an Inpatient Facility
7 Complications/Troubleshooting
8 Case Resolution
References
Intraosseous Line Placement for Medical Therapy in a Low-Resource Setting
1 Case Example
2 Introduction
3 Indications
4 Contraindications
5 Equipment/Supplies
6 Technique and Instructions for Use
6.1 Preparation
6.2 Placement of IO
7 Complications
8 Case Resolution
References
Intravenous Fluid Administration Without Programmable Infusion Pumps in a Low-Resource Setting
1 Case Example
2 Introduction
3 Indications
3.1 Supplies Needed for Manual Delivery of Intravenous Fluid (Figures under Section Discussed)
4 Types of Intravenous Fluid Administration Sets
5 Standard IV Fluid Administration Set
6 Microdrip Infusion Set with Volume Control Chamber
6.1 Blood Transfusion Set
7 Instructions for Calculating the Drip Rate for a Giving Set
7.1 How to Calculate Drip Rate for any Fluid Administration Set
7.2 Patient Safety Measures
8 Complications
9 Case Resolution (with Calculation)
10 Case Resolution
References
Mixing Intravenous Fluids in a Low-Resource Setting
1 Case Scenario 1
2 Introduction
3 Indications
4 Equipment/Supplies
5 Technique
5.1 Potassium
5.2 Other Electrolytes
6 Complications/Risks
7 Case Resolution
References
Further Reading
Respiratory Equipment Adaptations in a Low-Resource Setting
1 Spacer for a Metered Dose Inhaler
1.1 Case Example
1.2 Introduction
1.2.1 Indications
1.2.2 Equipment (Fig. 1)
1.2.3 Technique
1.2.4 Instructions for Use
1.2.5 Complications
1.3 Case Resolution
2 Nasopharyngeal Airway
2.1 Case Example
2.2 Introduction
2.2.1 Indications
2.2.2 Contraindications
2.2.3 Equipment
2.2.4 Technique
Fashioning an NPA from a Flexible Tube
2.2.5 Instructions for Use
2.2.6 Complications
2.3 Case Resolution
References
Bubble CPAP in a Low-Resource Setting
1 Case Example
2 Introduction
2.1 The Evidence
3 Indications
4 Contraindications
5 Equipment/Supplies
6 Technique/Instructions for Use
7 Instructions for Use
8 Complications/Monitoring/Troubleshooting
9 Case Resolution
References
Further Reading
Modified Chest Drainage System for Use in a Low-Resource Settings
1 Case Presentation
2 Introduction
3 Indications
3.1 Pleural Effusion
3.2 Hemothorax
3.3 Pneumothorax
4 Contraindications
5 Equipment
6 Technique
6.1 Heimlich Valve
6.2 Procedure Preparation
6.3 Monitoring
6.4 Procedural Sedation and Pain Management
7 Troubleshooting
8 Complications
8.1 Procedural Complications
9 Pearls
10 Case Resolution
References
Further Reading
Performing Lumbar Puncture in a Low-Resource Setting
1 Case Example
2 Introduction
3 Indications
4 Contraindications
5 Equipment/Supplies
5.1 Technique/Instructions for Use
5.1.1 Procedure with Adaptations
5.2 Complications
6 Case Resolution
References
Peritoneal Dialysis in a Low-Resource Setting
1 Case Example
2 Introduction
3 Indications
4 Contraindications
5 Supplies/Equipment
5.1 PD Catheter Options
5.1.1 Supplies Required for PD Catheter Placement (Fig. 2)
5.2 Technique
5.2.1 How to Make or Obtain PD Fluid and PD Fluid Sustainability
6 Instructions for Use
6.1 Basics on How to Do PD
6.2 PD Cycling
7 Complications/Troubleshooting
8 Case Resolution
References
Wound Vacuum-Assisted Closure Therapy in a Low-Resource Setting
1 Case Example
2 Introduction
3 Indications
3.1 Open Wound Categories
3.2 Contraindications
3.3 Relative Contraindication: Elevated Bleeding Risk
4 Equipment/Supplies
4.1 NPWT Component Options
4.1.1 Wound-Dressing Interface
4.2 Dressing Sealant
4.2.1 Adhesive Drapes
4.2.2 Suction Tubing
4.2.3 Suction Device
5 Technique/Instructions for Use
5.1 Wound-Dressing Interface
5.2 Suction
5.3 Monitoring Suction and Seal
5.4 NPWT Dressing Change Intervals
6 NPWT Endpoints
7 Complications
8 Case Resolution
References
Further Reading
Burn Care in a Low-Resource Setting
1 Case Example
2 Introduction
3 Classification of Burns
3.1 Burn Depth Determination
3.2 Body Surface Area Determination
4 Case Example Continuation
5 Burn Management: Initial Care and Evaluation
5.1 Pre-healthcare Facility
5.2 Medical Facility/Hospital Management
6 Burn Management: Fluid Resuscitation
7 Case Continuation
8 Burn Management: Wound Care
8.1 Burn Wound Care Steps
9 Burn Management: Pain Control and Nutrition
9.1 Pain Control and Sedation
9.2 Nutrition
10 Complications
11 Case Resolution
References
Unique Considerations for Simulation Use in a Low-Resource Setting
1 Introduction
2 Simulation for Preparing to Work in Resource-Limited Settings
2.1 SUGARPREP Curriculum
3 Simulation Training in Resource-Limited Settings
4 Case Example
5 Simulation Partnerships
6 Location, Technology, and Equipment
7 Case Design
8 Case Facilitation
8.1 Pre-brief
8.2 Case Facilitation
8.3 Debriefing
9 Virtual Simulation Adaptations
10 Conclusion
References
Practice and Implementation of Procedural Adaptations in a Low-Resource Setting
1 Self-Study and Available Resources
2 Importance of Hands-On Training and Supervision
3 Low-Cost Model Examples
4 Implementation in the Clinical Setting
5 Concluding Thoughts
Reference
Index
