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Introduction
Clinical presentation
Clin. aproach to ivestig. and menag. of UTI
Cortical scintigraphy in urinary tract infection
Cystigraphy in urinary tract infection
Vesicourethral reflux (VUR)
The grading systems for vesicourethral eflux
Detection of vesicourethral reflux
Micturating cystourethrography (MCUG)
Radionucleotide cystography (RNC)
Direct radionuclide cystography (DRC)
Indirect radionuclide cystography (IRC)
Dynamic renal scintigraphy in UTI
Practical problems in pediatric nucl.med.
Preparation
Dose schedule
Injection
Imobilisation/ sedation
Conclusion

6.4. IMOBILIZATION / SEDATION

Effective immobilization is extremely important to ensure good quality images. The various methods for gaining patient cooperation and immobilization may be tried. In the youngest age group, neonates to 2 years, simply holding the patient in place may be sufficient. Other techniques, such as sleep deprivation before the imaging procedure and feeding the child a bottle on the imaging table, may be equally successful in some patients. The use of sand bags, Velcro straps or if available vacuum extractor mattress and entertainment such as television, music, or reading stories also may be successful in patients older than 4 or 5 years age. Frequently, child may be so frightened, especially of the injection, that cooperation is impossible until his/her fears are allayed [19,5]. Parents are encouraged to stay with their child throughout the imaging procedure to support and amuse it with toys or books they have brought or that are available at the nuclear medicine department. Tired or agitated children might be better off with lights turned down and the opportunity to sleep [12]. It is important to listen carefully to the specific needs of the child. If possible, young children are examined during their day-time sleeping period. The favourite cartoon or film can be watched during the imaging. Sedation is not routinely required. There are, however, "difficult' children especially between ages 18 months and 3 years, in whom sedation helps. The most common indications for sedation are:

  • pronounced fear of venepucture
  • inability to cooperate during imaging
  • mental disability to cooperate,
  • past bed experiences; hospital fear[20].

In such cases oral chloral hydrate is useful. Intranasal sedation with Medazolan is gaining popularity since its action begins within 2-3 min but lasts only 20-30 min [5].

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