Guideline for Paediatric Cardiac OPD

1. All patients should have age appropriate growth chart in their file. The nurses should learn to plot the height and weight on the chart.
2. 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.
3. 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.
4. Guideline for the ordering of investigations:

General guideline:

1. • • 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.)

5. The chest X- ray on follow up would generally give the least data.
6. Do not feel bad about ordering no test e g. With small ASD/VSD
7. Further investigations may be done after the child has been seen, if needed.
8. 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.
9. A protocol for non-attenders is being considered.
10. 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.
11. SBE prophylaxis should always be recommended. Please examine the teeth for caries and refer to dentist if necessary.
12. Anemia in cyanosis cases should be avoided.
13. Be aware of giving Furosemide, especially in high doses without potassium sparing agent or potassium replacement
14. The cath report that is not in the file may be obtained from the old record on file.
15. Indicate on your ECHO request what information you would like.
16. All patients booked for catheterization or surgery should be discussed with the consultant.