VEPTR - NAPNAP · Standardizing VEPTR Incision Site Documentation ... 3.Neuromuscular dysfunction ... •Often at the junction between the porous metaphysis and the ...
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VEPTR expands outward to mimic the width of a typical child’s chest
Attaches to the ribs and either the ribs, pelvis or the spine.With permission, Campbell et.al; Thoracic insufficiency syndrome.Curr Probl Pediatr Health Care 2016 Mar; 46(3):72‐97.
• Provide a consistent approach when communicating a VEPTR patient’s incision sites across the organization
• Standardize SSI documentation using the Center for Thoracic Insufficiency Syndrome (CTIS) Incision Site Schematic (ISS) for all skin & wound issues related to a VEPTR procedure
• Educate at least 80% of the patients/families using the ISS
Patient Family Education: VEPTR Care Post Surgery• When can I remove my child’s dressing?• Remove your child’s secondary or cover dressing on (Date:)____• How to Care for the spine dressing• When can my child shower or take a bath?• How do I care for my child’s incision?• Signs/symptoms of infection
• Ortho attending documents the specific sites in the CTIS physician survey (REDCap)
• Nursing‐newly created LDA specific to VEPTR incisions (active in EHR)– Will allow for easy identification of which sites have concerns
• Nursing & Inpatient NP’s complete PFE sheet (ISS) & educate families prior to discharge– An image of the completed ISS sheet is uploaded into the patient’s media tab
• Outpatient NP’s & coordinators utilize the ISS (media tab) to follow up with the families post operatively
• Parents use the ISS sheet provided when concerned about an incision site “PFE:VEPTR Care Post Surgery”
My Kid Falls ALL the Time: Common Causes of In-toeing
• Learning Objectives – Understand the 3 most common causes of in-toeing – Describe treatment for 3 the most common causes of in-toeing – Understand when to refer and when to watch
• In-toeing
– Very common – Most resolves spontaneously
Treatment for all 3:
– Reassurance – Reassurance – 2nd opinion for reassurance
• Evaluation
– Thorough H&P – Family history – Pain? – Height/Weight – LLD? – Neuro exam
• Femoral Anterversion
– Normal anterversion 15° to 20° – Increases until age 4 or 5 – Resolved by age 10-12 – “W” sitting- don’t worry about it – Surgical treatment-RARE
• Osteotomy if functionally limiting by early teen
• Overuse injuries• Accumulated microtrauma from repetitive strain• Small but progressive cracks in the periosteum• Adolescents• Female > males• Locations: tibia, fibula, pars interarticularis (spondylolysis) and femur
• Radiographic findings don’t present until 1‐2 weeks of symptoms
• Fracture in a child < 1 year• Lower extremity fracture in a non‐ambulatory child• Posterior rib fractures• Metaphyseal lesions (bucket‐handle or corner fractures)• Bilateral long bone fractures• Complex skull fractures• Spinous process fractures• Repeat fracture in an unusual location• Stage of healing that is inconsistent with injury description• Multiple fractures in various stages of healing • Mandatory reporter
1. Document vascular, sensory, and motor function before and after immobilization. Immobilize above and below the site of injury, generally in a position of function.
2. Immediate consultation with orthopedics for all findings on previous slide.
3. Consult orthopedics whenever you have a question. If you consult an attending physician, follow‐up with that physician.
4. With any fracture (except torus), the fracture could progress (even in a cast).
5. True buckle/torus fractures should not demonstrate completion of fracture through volar cortex and should not have angulation.
6. Elbows: for children < 6 years, consider obtaining comparative lateral film of contralateral elbow; for condyle fractures, consider obtaining oblique view to more clearly delineate amount of displacement.
7. Any displacement at a growth plate should prompt a consult to ortho.
8. Ensure good after‐care instructions, pain control, and specify follow‐up (ortho or PCP and timing).
9. These guidelines are very generalized. Care must be taken to alter treatment according to individualized patient situation.
Clavicle 1. Clavicle strap with sling or cuff & collar2. Sling & swath
7‐15 days ortho or PCP*ortho if athlete/teen
Humerus‐proximal Sling & swath 5‐7 days
Humerus‐shaft Sugar tong splint with sling & swath 5‐7 days
Elbow‐lateral condyle<2mm displacementElbow‐medial condyle<2mm displacementSupracondylar Type 1Non‐angulated Type 2
1. Long‐Arm posterior splint (elbow 90) with cuff & collar (simple sling for older kids)2. Long‐Arm cast (elbow 90) with C&C or SS only with mild edema
3‐7 days
Supracondylar Angulated Type 2 All Type 3
Long‐Arm posterior splint with C&C Immediate consult with ortho
Olecranon 1. Long‐Arm posterior splint with C&C or SS2. Long‐Arm cast with C&C or SS if mild edema (partial elbow extension 110‐120)
• Mathison, D.J., & Aggrawal, D. (2017). General principles of fracture management: Fracture patterns and description in children. In R.G. Bachur (Ed.), UpToDate. Watham, Mass.: UpToDate. Retrieved from www.uptodate.com
• Burns, C.E., Dunn, A.M., Brady, M.A., Starr, N.B., Blosser, C.G. & Garzon, D. L.(2017). Pediatric primary care: A handbook for nurse practitioners (6th Ed). Philadelphia: W.B. Saunders Company.