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Central venous access devices (long term)

The purpose of this guideline is to provide guidance on the care and use of long term Central Venous Access Devices (CVAD) including advice on dealing with any problems encountered. For the purpose of this guideline, devices that are required to remain insitu greater than a month will be considered a long term CVAD.

Note: While this guideline refers to the 'child' throughout, all activities are applicable to young people

Warfarin

Warfarin is an anticoagulant medication (known as a ‘blood thinner’) that will slow down blood clotting to prevent abnormal blood clots from developing or worsening. This page from Great Ormond Street Hospital (GOSH) explains about the anticoagulant (blood thinner) medication warfarin, how it should be taken and how it will be monitored. 

Gastrostomy management

A gastrostomy is a feeding tube that is inserted directly into the stomach either surgically under direct vision (open or laproscopic), endoscopically (with a camera), or radiologically (x-ray guidance). A gastrostomy tube allows the delivery of supplemental nutrition and medications directly into the stomach. It also provides a mechanism to drain gastric contents if required. In order for gastrostomy feeding to be successful the child or young person must have a functioning gastrointestinal tract.

Ketogenic diet

The ketogenic diet (KD) is a therapeutic diet, which has been shown to improve seizure control in patients with drug resistant epilepsy, and is used in some patients with metabolic conditions for example, glucose transporter type 1 deficiency syndrome (GLUT1) and pyruvate dehydrogenase deficiency (PDH).

NOTE: We review our guidelines regularly and this guideline is now past its review date. The content of the guideline below may not reflect the most recent evidence based practice. Please use with caution.

Plastics physiotherapy

The plastics physiotherapist at Great Ormond Street Hospital (GOSH) sees children with a wide range of problems. Some of these problems are present at birth (congenital) and some may have developed in childhood. Children who need plastic or reconstructive surgery are seen as outpatients, day case patients or inpatients. Children and young people need to be referred to physiotherapy by the plastics medical team before they are reviewed.

Neurodisability services

The Occupational Therapy team provide input into the Neurodisability clinics at Great Ormond Street Hospital (GOSH), working collaboratively as part of the multidisciplinary team. The occupational therapist will discuss your child’s current functional skills and assess their ability to carry out age appropriate self-care and school based tasks. Following the assessment, advice to support your child’s occupational performance is offered to local services to ensure continuity of care.