Mark Wulkan

176 statements · 8 topics · summaries given as host listed separately

Abdominal Wall Defects · guest expert Choledochal Cyst / Biliary · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert Pectus Excavatum · guest expert

Featured statements

I actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off.
quote · Gastroesophageal Reflux Disease
I do them, so I've done them with a medical student. And you can do a laparoscopic sleeve with a medical student and it still doesn't take that long.
quote · Obesity
Where the azygous vein comes into the superior vena cava the SVC almost always recanalizes.
quote · Gastroesophageal Reflux Disease
I think that's level 5 evidence, Todd.
quote · Congenital Lung Lesions (CPAM)
For oncology patients receiving vesicant chemotherapy such as Adriamycin that causes tissue necrosis if infiltrated, a cuffed external catheter (Broviac) is preferred over a subcutaneous port.
guideline · Thrombosis
Standard heparin lock concentrations are 10 units/mL for accessed catheters (ports and cuffed lines), 100 units/mL for non-accessed buried ports, and 1000 units/mL for dialysis catheters.
guideline · Thrombosis

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Mark's statements about Congenital Lung Lesions (CPAM) 42 statements

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Complications and Beyond

Statement If chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays Open
Statement If chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays Open
Quotation We're not gonna change this. We're not gonna change this. Keep going. Open
Quotation We're not gonna change this. We're not gonna change this. Keep going. Open
Statement Three months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty Open
Statement Three months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty Open
Quotation I think you ought to get a CT at 3 months and act on it accordingly. Open
Quotation I think you ought to get a CT at 3 months and act on it accordingly. Open
Statement For thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers Open
Statement For thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers Open
Statement Energy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices Open
Statement Energy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices Open
Statement Staplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication Open
Statement Staplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication Open
Quotation It's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience. Open
Quotation It's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience. Open
Statement Before firing any vessel control device, think through the next two steps if the device fails Open
Statement Before firing any vessel control device, think through the next two steps if the device fails Open
Statement Paraesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization Open
Statement Paraesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization Open
Statement Biologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen Open
Statement Biologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen Open
Statement Horseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site Open
Statement Horseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site Open
Statement If temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases Open
Statement If temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases Open
Statement Dilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux Open
Statement Dilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux Open
Statement After Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience Open
Statement After Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience Open
Statement If operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo Open
Statement If operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo Open
Statement Bougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction Open
Statement Bougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction Open
Statement Gastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged Open
Statement Gastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged Open
Statement Gastric disconnect can be performed thoracoscopically Open
Statement Gastric disconnect can be performed thoracoscopically Open
Quotation I think that's level 5 evidence, Todd. Open
Quotation I think that's level 5 evidence, Todd. Open
Statement In esophageal lung, right lung is aerated through esophageal fistula rather than tracheal connection Open
Statement In esophageal lung, right lung is aerated through esophageal fistula rather than tracheal connection Open
Mark's statements about Congenital Pulmonary Airway Malformation 21 statements

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Complications and Beyond

Statement If chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays Open
Quotation We're not gonna change this. We're not gonna change this. Keep going. Open
Statement Three months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty Open
Quotation I think you ought to get a CT at 3 months and act on it accordingly. Open
Statement For thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers Open
Statement Energy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices Open
Statement Staplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication Open
Quotation It's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience. Open
Statement Before firing any vessel control device, think through the next two steps if the device fails Open
Statement Paraesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization Open
Statement Biologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen Open
Statement Horseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site Open
Statement If temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases Open
Statement Dilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux Open
Statement After Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience Open
Statement If operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo Open
Statement Bougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction Open
Statement Gastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged Open
Statement Gastric disconnect can be performed thoracoscopically Open
Quotation I think that's level 5 evidence, Todd. Open
Statement In esophageal lung, right lung is aerated through esophageal fistula rather than tracheal connection Open
Mark's statements about Esophageal Atresia 21 statements

Open the Esophageal Atresia collection →

Complications and Beyond

Statement If chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays Open
Quotation We're not gonna change this. We're not gonna change this. Keep going. Open
Statement Three months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty Open
Quotation I think you ought to get a CT at 3 months and act on it accordingly. Open
Statement For thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers Open
Statement Energy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices Open
Statement Staplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication Open
Quotation It's always good to have that ready, you know, unfortunately, I'm, uh, I, I, my knowledge is all from experience. Open
Statement Before firing any vessel control device, think through the next two steps if the device fails Open
Statement Paraesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization Open
Statement Biologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen Open
Statement Horseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site Open
Statement If temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases Open
Statement Dilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux Open
Statement After Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience Open
Statement If operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo Open
Statement Bougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction Open
Statement Gastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged Open
Statement Gastric disconnect can be performed thoracoscopically Open
Quotation I think that's level 5 evidence, Todd. Open
Statement In esophageal lung, right lung is aerated through esophageal fistula rather than tracheal connection Open
Mark's statements about Gastroesophageal Reflux Disease 25 statements

Open the Gastroesophageal Reflux Disease collection →

Pediatric Vascular Access

Statement In micro-preemies (1000g to 2kg), a 3-French soft silastic cuffed catheter is preferred because larger catheters that fill the vessel lumen increase the risk of vessel thrombosis. Open
Quotation I think that there's probably a lot more thrombosis that goes on than we realize. Open
Statement A needle-hole venotomy technique for neonatal IJ access involves isolating the vein, making a needle puncture without formal venotomy, and advancing a beveled catheter through the puncture site to preserve vein patency for future access. Open
Quotation I actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off. Open
Statement Beveling the catheter tip for needle-hole venotomy was associated with slightly more catheter thrombosis in one study compared to straight-cut catheters, but the technique is justified to preserve the vein. Open
Quotation I've even gone back and had to do a second cut down on some of these kids, and the vein is in fact patent. Open
Statement When ultrasound-guided needle placement appears to be in the vein but no blood return is obtained in small infants, the needle may have passed through the collapsed vein and withdrawing it slightly may establish access. Open
Statement For oncology patients receiving vesicant chemotherapy such as Adriamycin that causes tissue necrosis if infiltrated, a cuffed external catheter (Broviac) is preferred over a subcutaneous port. Open
Statement MRV is the gold standard imaging study for evaluating central venous patency in patients with multiple prior lines or history of thrombosis. Open
Statement A glide wire can sometimes be advanced through a partially occluded superior vena cava when a standard guide wire will not pass. Open
Quotation Sometimes you can get the slippery wires right past the clot. Open
Statement For infected central lines, if the patient has peripheral IV access, the infected line should be removed and peripheral access used temporarily rather than exchanging over a wire, which risks infecting the new line. Open
Quotation I'm always anxious putting another central line in the face of infection because the chances are that line's going to get infected. Open
Statement Ideally, blood cultures should be negative for 48 hours before placing a new central line after removal of an infected catheter. Open
Statement Femoral venous access in neonates frequently results in leg swelling and should be avoided in this population. Open
Statement Routine preoperative coagulation studies (PT/PTT) are not indicated for central line placement unless the patient is anticoagulated or has liver failure; platelet function assay (PFA) is more useful when coagulopathy is suspected. Open
Statement Standard heparin lock concentrations are 10 units/mL for accessed catheters (ports and cuffed lines), 100 units/mL for non-accessed buried ports, and 1000 units/mL for dialysis catheters. Open
Statement Prophylactic ethanol lock therapy is being used in some bone marrow transplant patients to reduce catheter-related bloodstream infection rates. Open
Statement For catheter-related infections with gram-positive organisms, treatment with antibiotics through the catheter plus ethanol lock can successfully clear the infection approximately 50% of the time; for gram-negative infections, clearance rate is lower. Open
Statement Catheter-related fungal infections (Candida) require line removal; salvage attempts are not appropriate. Open
Quotation Where the azygous vein comes into the superior vena cava the SVC almost always recanalizes. Open
Statement For patients with complete central venous occlusion, thoracoscopic-assisted needle puncture of the SVC can be performed by advancing a needle through the thrombosed IJ tract under direct visualization; the SVC almost always recanalizes at the azygous vein junction. Open
Quotation I can tell you the first couple of times I did this, my heart rate was up too, but it's really, it's pretty straightforward. Open
Statement For thoracoscopic SVC access in larger adolescents, the standard line kit needle may not be long enough and an extra-long spinal needle may be required. Open
Statement Some older silicone catheters become chalky and friable over time, possibly due to betadine exposure, making removal difficult. Open
Mark's statements about Obesity 10 statements

Open the Obesity collection →

Guillermo Ares, MD and Mark Wulkan, MD - 2024 Pediatric Bariatric Surgery Update Course

Quotation so Guillermo, you're telling me that the robot's almost as good as, uh, laparoscopic surgery. Is that what you're saying? Open
Quotation the urologists all want it because they don't learn how to do the laparoscopic suturing like we do. Open
Statement Urologists want robotic surgery because they don't learn laparoscopic suturing like general surgeons do. Open
Quotation all you did, Guillermo, is tell me that you showed, there's, you showed me that the robot is almost as good as straight laparoscopic, only it's more expensive and takes longer. Open
Quotation I do them, so I've done them with a medical student. And you can do a laparoscopic sleeve with a medical student and it still doesn't take that long. Open
Quotation I, I think it's a technology that is still in its infancy. Open
Statement Laparoscopic sleeve gastrectomy can be performed with a medical student assistant without taking excessive time. Open
Statement Two other robotic platforms are coming on the market this year, which should create competition and improve instruments and decrease costs. Open
Statement Robotic technology is still in its infancy. Open

Introduction - 2024 Pediatric Bariatric Surgery Update Course

Statement Mark Wolcon is Chair of Surgery at Akron Children's Hospital and a pediatric bariatric surgeon. Open
Mark's statements about Pediatric Obesity 7 statements

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Welcome & Introduction: Pediatric Obesity 2017

Quotation Good morning, good afternoon, and good evening. Welcome to the latest evidence and trends in pediatric obesity. Open
Statement Dr. Mark Wolco is the surgeon-in-chief at Children's Healthcare of Atlanta and part of the Strong for Life program as the bariatric surgeon. Open
Statement This is the fifth year of the pediatric obesity global cast hosted by Children's Healthcare of Atlanta. Open
Quotation This is the 5th year we've been doing this pediatric obesity global cast, and I think it's gonna be our best one yet. Open
Statement Dr. Stephanie Walsh is an associate professor of surgery and pediatrics and the medical director of wellness in the Strong for Life clinic at Children's Healthcare of Atlanta. Open
Statement Dr. Chris Bowling is a private practice pediatrician in Kentucky and the chair of the section on obesity of the American Academy of Pediatrics. Open
Quotation If you get a blank screen, don't panic, we'll get it fixed. Open
Mark's statements about Thrombosis 25 statements

Open the Thrombosis collection →

Pediatric Vascular Access

Statement In micro-preemies (1000g to 2kg), a 3-French soft silastic cuffed catheter is preferred because larger catheters that fill the vessel lumen increase the risk of vessel thrombosis. Open
Quotation I think that there's probably a lot more thrombosis that goes on than we realize. Open
Quotation I actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off. Open
Statement A needle-hole venotomy technique for neonatal IJ access involves isolating the vein, making a needle puncture without formal venotomy, and advancing a beveled catheter through the puncture site to preserve vein patency for future access. Open
Statement Beveling the catheter tip for needle-hole venotomy was associated with slightly more catheter thrombosis in one study compared to straight-cut catheters, but the technique is justified to preserve the vein. Open
Quotation I've even gone back and had to do a second cut down on some of these kids, and the vein is in fact patent. Open
Statement When ultrasound-guided needle placement appears to be in the vein but no blood return is obtained in small infants, the needle may have passed through the collapsed vein and withdrawing it slightly may establish access. Open
Statement For oncology patients receiving vesicant chemotherapy such as Adriamycin that causes tissue necrosis if infiltrated, a cuffed external catheter (Broviac) is preferred over a subcutaneous port. Open
Statement MRV is the gold standard imaging study for evaluating central venous patency in patients with multiple prior lines or history of thrombosis. Open
Statement A glide wire can sometimes be advanced through a partially occluded superior vena cava when a standard guide wire will not pass. Open
Quotation Sometimes you can get the slippery wires right past the clot. Open
Statement For infected central lines, if the patient has peripheral IV access, the infected line should be removed and peripheral access used temporarily rather than exchanging over a wire, which risks infecting the new line. Open
Quotation I'm always anxious putting another central line in the face of infection because the chances are that line's going to get infected. Open
Statement Ideally, blood cultures should be negative for 48 hours before placing a new central line after removal of an infected catheter. Open
Statement Femoral venous access in neonates frequently results in leg swelling and should be avoided in this population. Open
Statement Routine preoperative coagulation studies (PT/PTT) are not indicated for central line placement unless the patient is anticoagulated or has liver failure; platelet function assay (PFA) is more useful when coagulopathy is suspected. Open
Statement Standard heparin lock concentrations are 10 units/mL for accessed catheters (ports and cuffed lines), 100 units/mL for non-accessed buried ports, and 1000 units/mL for dialysis catheters. Open
Statement Prophylactic ethanol lock therapy is being used in some bone marrow transplant patients to reduce catheter-related bloodstream infection rates. Open
Statement For catheter-related infections with gram-positive organisms, treatment with antibiotics through the catheter plus ethanol lock can successfully clear the infection approximately 50% of the time; for gram-negative infections, clearance rate is lower. Open
Statement Catheter-related fungal infections (Candida) require line removal; salvage attempts are not appropriate. Open
Statement For patients with complete central venous occlusion, thoracoscopic-assisted needle puncture of the SVC can be performed by advancing a needle through the thrombosed IJ tract under direct visualization; the SVC almost always recanalizes at the azygous vein junction. Open
Quotation Where the azygous vein comes into the superior vena cava the SVC almost always recanalizes. Open
Quotation I can tell you the first couple of times I did this, my heart rate was up too, but it's really, it's pretty straightforward. Open
Statement For thoracoscopic SVC access in larger adolescents, the standard line kit needle may not be long enough and an extra-long spinal needle may be required. Open
Statement Some older silicone catheters become chalky and friable over time, possibly due to betadine exposure, making removal difficult. Open
Mark's statements about Vascular Access 25 statements

Open the Vascular Access collection →

Pediatric Vascular Access

Statement In micro-preemies (1000g to 2kg), a 3-French soft silastic cuffed catheter is preferred because larger catheters that fill the vessel lumen increase the risk of vessel thrombosis. Open
Quotation I think that there's probably a lot more thrombosis that goes on than we realize. Open
Statement A needle-hole venotomy technique for neonatal IJ access involves isolating the vein, making a needle puncture without formal venotomy, and advancing a beveled catheter through the puncture site to preserve vein patency for future access. Open
Quotation I actually just put it, make a needle hole with the needle that comes in the kit in the vein, and then I have the catheter already tunneled and trimmed. And I will slide the catheter into that needle hole so that you don't ligate the vein. I don't tie it off. Open
Statement Beveling the catheter tip for needle-hole venotomy was associated with slightly more catheter thrombosis in one study compared to straight-cut catheters, but the technique is justified to preserve the vein. Open
Quotation I've even gone back and had to do a second cut down on some of these kids, and the vein is in fact patent. Open
Statement When ultrasound-guided needle placement appears to be in the vein but no blood return is obtained in small infants, the needle may have passed through the collapsed vein and withdrawing it slightly may establish access. Open
Statement For oncology patients receiving vesicant chemotherapy such as Adriamycin that causes tissue necrosis if infiltrated, a cuffed external catheter (Broviac) is preferred over a subcutaneous port. Open
Statement MRV is the gold standard imaging study for evaluating central venous patency in patients with multiple prior lines or history of thrombosis. Open
Statement A glide wire can sometimes be advanced through a partially occluded superior vena cava when a standard guide wire will not pass. Open
Quotation Sometimes you can get the slippery wires right past the clot. Open
Statement For infected central lines, if the patient has peripheral IV access, the infected line should be removed and peripheral access used temporarily rather than exchanging over a wire, which risks infecting the new line. Open
Quotation I'm always anxious putting another central line in the face of infection because the chances are that line's going to get infected. Open
Statement Ideally, blood cultures should be negative for 48 hours before placing a new central line after removal of an infected catheter. Open
Statement Femoral venous access in neonates frequently results in leg swelling and should be avoided in this population. Open
Statement Routine preoperative coagulation studies (PT/PTT) are not indicated for central line placement unless the patient is anticoagulated or has liver failure; platelet function assay (PFA) is more useful when coagulopathy is suspected. Open
Statement Standard heparin lock concentrations are 10 units/mL for accessed catheters (ports and cuffed lines), 100 units/mL for non-accessed buried ports, and 1000 units/mL for dialysis catheters. Open
Statement Prophylactic ethanol lock therapy is being used in some bone marrow transplant patients to reduce catheter-related bloodstream infection rates. Open
Statement For catheter-related infections with gram-positive organisms, treatment with antibiotics through the catheter plus ethanol lock can successfully clear the infection approximately 50% of the time; for gram-negative infections, clearance rate is lower. Open
Statement Catheter-related fungal infections (Candida) require line removal; salvage attempts are not appropriate. Open
Statement For patients with complete central venous occlusion, thoracoscopic-assisted needle puncture of the SVC can be performed by advancing a needle through the thrombosed IJ tract under direct visualization; the SVC almost always recanalizes at the azygous vein junction. Open
Quotation Where the azygous vein comes into the superior vena cava the SVC almost always recanalizes. Open
Quotation I can tell you the first couple of times I did this, my heart rate was up too, but it's really, it's pretty straightforward. Open
Statement For thoracoscopic SVC access in larger adolescents, the standard line kit needle may not be long enough and an extra-long spinal needle may be required. Open
Statement Some older silicone catheters become chalky and friable over time, possibly due to betadine exposure, making removal difficult. Open

Summaries Mark gave as host · 24 summaries

Recaps of other experts' statements, not Mark's own clinical position.

Summaries Mark gave as host · Choledochal Cyst / Biliary 2 summaries

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Journal of pediatric surgery Article Review: April 2023, IPEG issue

Host summary Mark Wulkan summarizing the discussion: The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed. Open
Host summary Mark Wulkan summarizing the discussion: There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types. Open
Summaries Mark gave as host · Gastroesophageal Reflux Disease 6 summaries

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Pediatric Vascular Access

Host summary Mark Wulkan summarizing a resource: The atrial-caval junction is located deeper on chest radiograph than many surgeons estimate, often at a level that appears to be within the superior atrium. Open
Host summary Mark Wulkan summarizing a resource: Ultrasound in the adult world seems to have become the standard of care for line placement. Open
Host summary Mark Wulkan summarizing a resource: A 2013 JACS study by Dutta, St. Peter and others showed that ultrasound-guided IJ access achieved first-pass success in 65% of cases versus 45% with landmark technique, and 95% success by three attempts versus 74% with landmark technique. Open
Host summary Mark Wulkan summarizing a resource: In adult literature, the number of needle passes is a validated proxy marker for complication risk in central line placement. Open
Host summary Mark Wulkan summarizing a resource: Antibiotic-coated and heparin-coated temporary central venous catheters have been shown to decrease catheter-related bloodstream infection rates. Open
Host summary Mark Wulkan summarizing a resource: The ASBS Outcomes Committee meta-analysis in 2011 found Class A or B evidence that chlorhexidine-alcohol skin preparation decreases catheter-related bloodstream infections compared to betadine-based preparations. Open
Summaries Mark gave as host · Obesity 2 summaries

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Guillermo Ares, MD and Mark Wulkan, MD - 2024 Pediatric Bariatric Surgery Update Course

Host summary Mark Wulkan summarizing the discussion: Comparative studies between robotic and laparoscopic bariatric surgery show really no difference in outcomes. Open
Host summary Mark Wulkan summarizing the discussion: A large study from the MBSQIP database of almost 800,000 patients showed slightly lower infectious complications with robotic Roux-en-Y but higher infectious complications with robotic sleeve, and higher 30-day readmission and reoperation rates with robotic surgery. Open
Summaries Mark gave as host · Pectus Excavatum 2 summaries

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Journal of pediatric surgery Article Review: April 2023, IPEG issue

Host summary Mark Wulkan summarizing the discussion: The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed. Open
Host summary Mark Wulkan summarizing the discussion: There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types. Open
Summaries Mark gave as host · Thrombosis 6 summaries

Open the Thrombosis collection →

Pediatric Vascular Access

Host summary Mark Wulkan summarizing a resource: The atrial-caval junction is located deeper on chest radiograph than many surgeons estimate, often at a level that appears to be within the superior atrium. Open
Host summary Mark Wulkan summarizing a resource: A 2013 JACS study by Dutta, St. Peter and others showed that ultrasound-guided IJ access achieved first-pass success in 65% of cases versus 45% with landmark technique, and 95% success by three attempts versus 74% with landmark technique. Open
Host summary Mark Wulkan summarizing a resource: Ultrasound in the adult world seems to have become the standard of care for line placement. Open
Host summary Mark Wulkan summarizing a resource: In adult literature, the number of needle passes is a validated proxy marker for complication risk in central line placement. Open
Host summary Mark Wulkan summarizing a resource: Antibiotic-coated and heparin-coated temporary central venous catheters have been shown to decrease catheter-related bloodstream infection rates. Open
Host summary Mark Wulkan summarizing a resource: The ASBS Outcomes Committee meta-analysis in 2011 found Class A or B evidence that chlorhexidine-alcohol skin preparation decreases catheter-related bloodstream infections compared to betadine-based preparations. Open
Summaries Mark gave as host · Vascular Access 6 summaries

Open the Vascular Access collection →

Pediatric Vascular Access

Host summary Mark Wulkan summarizing a resource: The atrial-caval junction is located deeper on chest radiograph than many surgeons estimate, often at a level that appears to be within the superior atrium. Open
Host summary Mark Wulkan summarizing a resource: Ultrasound in the adult world seems to have become the standard of care for line placement. Open
Host summary Mark Wulkan summarizing a resource: A 2013 JACS study by Dutta, St. Peter and others showed that ultrasound-guided IJ access achieved first-pass success in 65% of cases versus 45% with landmark technique, and 95% success by three attempts versus 74% with landmark technique. Open
Host summary Mark Wulkan summarizing a resource: In adult literature, the number of needle passes is a validated proxy marker for complication risk in central line placement. Open
Host summary Mark Wulkan summarizing a resource: Antibiotic-coated and heparin-coated temporary central venous catheters have been shown to decrease catheter-related bloodstream infection rates. Open
Host summary Mark Wulkan summarizing a resource: The ASBS Outcomes Committee meta-analysis in 2011 found Class A or B evidence that chlorhexidine-alcohol skin preparation decreases catheter-related bloodstream infections compared to betadine-based preparations. Open