- All patients should have age appropriate growth chart in their file. The nurses should learn to plot the height and weight on the chart.
- All the doctors should start the clinic promptly on time at 0830 hours. The registers should only leave the clinic with the permission of the attending consultant.
- Files will be checked by the attending consultant with registers attending (if possible, in a learning capacity), preferably the day before. The doctor will order any investigations needed for the clinic.
- Guideline for the ordering of investigations:
- Chest X-ray, ECG, ECHO should not be done on each child who is seen for follow up. New cases however, generally should complete all the 3 investigations.
- Decide which would be the best test for follow-up cases and be able to supply a logical reason for this.
Example I: A patient who has PS/AS: The best single follow up would be an Echo to measure the gradient (peak) instantaneous gradient and mean instantaneous gradient. (MIG)
Example II: A patient with a systemic pulmonary artery shunt, Glenn operation or Tetralogy of Fallot pre-op (any other causes of reduced PBF)
The FBC (Hb, Hct, MCV, and MCH) would measure the adequacy of PBF better than an ECHO and detect anaemia.
Example III: A post-operative Mustard/ Senning:
The ECG & ECHO would give the best information
Example IV: A Post-operative CoA
The echo measure of a large diastolic tail and BP pressure gradient would give the best data (right arm & both legs)
Example V: Alternate tests if both ECG &Chest X-ray deemed necessary (ECG this visit & Chest X-ray next visit.)
- The chest X- ray on follow up would generally give the least data.
- Do not feel bad about ordering no test e g. With small ASD/VSD
- Further investigations may be done after the child has been seen, if needed.
- All patients who have had surgery should have at least 1 post op ECHO to note the adequacy of the surgery and any residual lesions.
- A protocol for non-attenders is being considered.
- The follow-up intervals should be carefully considered. Excellent results for VSD and ASD closure of TOF repair need only be seen every 2-3 years. More frequent follow up should be reserved for the children who are ill and need to be seen frequently.
- SBE prophylaxis should always be recommended. Please examine the teeth for caries and refer to dentist if necessary.
- Anemia in cyanosis cases should be avoided.
- Be aware of giving Furosemide, especially in high doses without potassium sparing agent or potassium replacement
- The cath report that is not in the file may be obtained from the old record on file.
- Indicate on your ECHO request what information you would like.
- All patients booked for catheterization or surgery should be discussed with the consultant.