Pediatric Interventional Radiology Guideline

Original Date: 01/2026

Categories of IR Activation for Pediatric Trauma Patients (<16 yo)

IR STAT Trauma – Procedure initiated within 60 minutes of consultation

Indications:

  • Patients with zone 3 REBOA with negative FAST (i.e. not requiring surgical hemorrhage control)
  • Active vascular extravasation requiring transfusion
  • IR required during operation (e.g. hepatic or pelvic packing)

Location:

  1. Hybrid operating room (OR41) if patient is unstable, may require surgery, or already in surgery
    • OR and IR nursing team provides care in the hybrid OR suite
    • Adult trauma anesthesia will hand over to pediatric anesthesia when appropriate
    • Supplies are communicated by IR faculty performing the procedure to the IR tech who will bring additional supplies if child is too small to use the supplies in OR 41
  2. If stable and not requiring surgery, IR angio suite is preferred: Jones 2 Angio 1 or 2, or Ground Floor Hermann – Peds IR
    • IR nursing team would provide full support
    • Pediatric anesthesia will provide anesthesia
    • Supplies are fully stocked here, preferred location for appropriate patient

Process for IR STAT Trauma in the Hybrid OR:

  1. When the pediatric surgery attending identifies a patient requiring emergent hemorrhage control from interventional radiology (IR), the pediatric surgery team activates trauma IR pager through the page operator (4-3333) by requesting “IR STAT Trauma.” The decision to activate the IR STAT Trauma pager must be made by the pediatric surgery attending/fellow or trauma surgery attending
  2. The pediatric surgery attending calls the adult trauma attending to verify that the hybrid room is available for use
    **If not – call IR Attending cell phone to make decision on location and timing and refer to next section
  3. The pediatric surgery team calls the OR front desk (4-4042) to post the emergent case in OR 41. Post for STAT IR angiography/embolization (specify location if known – pelvis, spleen, liver, etc) under pediatric surgery faculty name.
  4. The pediatric surgery attending calls the pediatric anesthesia team (4-0260) to notify of STAT IR activation. If pediatric anesthesia is not available, adult anesthesia is called (4-7979).
  5. The pediatric surgery team, trauma team, and ED or ICU nursing transports the patient to OR 41
  6. The pediatric surgery team (faculty or fellow if available) calls the IR Faculty (AMION – Houston IR, “second call.” Use the cell phone number) to specify location of procedure in OR 41 and location of bleeding.
  7. All IR team members, including faculty, resident, tech, and nurse, will receive a page stating “STAT Trauma IR” and immediately report to the hybrid OR
  8. The IR RN places verbal order in Epic under the pediatric surgery attending for IR Consult Order
  9. The IR team places the procedure on the snapboard
  10. When the IR team (including faculty) arrive to the hybrid OR, the trauma/pediatric surgery team will receive a page stating “IR Team is Ready.”

Process for IR STAT Trauma in the IR Suite:  Decision to be made by IR Boardrunner during work hours or IR Attending during off hours.  Jones 2 Angio 1 or 2 vs. Ground Floor Hermann – Peds IR

  1. When the pediatric surgery attending identifies a patient requiring emergent hemorrhage control from interventional radiology (IR), the pediatric surgery team activates the trauma IR pager through the page operator (4-3333) by requesting “IR STAT Trauma to IR Angio Suite.” The decision to activate the IR STAT Trauma pager must be made by the pediatric surgery attending/fellow or trauma attending
  2. The pediatric surgery team (faculty or fellow if available) calls the IR faculty on call (AMION – Houston IR, “second call.”  Use the cell phone number) to specify location of procedure in the IR suite, and location of the bleeding
  3. After activating IR STAT Trauma, the pediatric surgery team will notify Anesthesia (4-0260) of the need for assistance in IR.
  4. The pediatric surgery team places IR Consult Order in Epic
  5. The IR team places the procedure on the snapboard.
  6. The pediatric surgery team and ED or ICU nursing staff transport the patient to the IR suite
  7. All IR team members, including faculty, resident, tech, and nurse, will receive a page stating “STAT Trauma IR” and immediately report to the IR suite
  8. When IR team is ready (including faculty) the pediatric surgery / trauma team will get a page stating “IR team is ready”

IR Trauma Consult – Procedure initiated within 24 hours

  1. Indications:
    1. Pediatric surgeon discretion with the following findings:
      1. Active extravasation of solid organ injury with stable vitals but ongoing transfusion requirement / failure of non-operative management
      2. Pseudoaneurysm of solid organ injury with stable vitals but ongoing transfusion requirement / failure of non-operative management
    2. Location:
      1. Pediatric IR Suite (weekdays), Adult IR Suite (weekends/nights)
    3. IR Physicians Involved – Pediatric IR physician on call
    4. Process for consult – call first call for IR (resident)
    5. Place IR Consult Order in Epic
    6. Call Outside Anesthesia Board Runner (4-0026) to coordinate anesthesia.