RSS Feed Print Category View
Endocavitary Probes for PTA Ultrasound
pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


Dear colleagues,

We recently have developed a 'discussion' with the head of our Diagnostic imaging who deems it unsavory (and therefore has disallowed us)  to use the same probe for transvaginal studies as we do for looking for peritonsilar abscesses.   We have a strict cleaning protocol that goes through the ultrasound department itself.  They have now stated that if we are to continue to perform ultrasounds for peritonsilar abscess we will need a separate probe.  In order to prevent our use they have currently removed the probe from the ED department until we have this topic resolved. My department will not pay for a separate probe for this matter as very few physicians in our group would use it for this.  I was wondering if anyone else has dealt with this or a similar issue and what recommendations you would have.  

Please let me know.  

Jamie Jenkins MD RDMS
Regional Ultrasound Director FHS
Emergency Medicine Attending Physician
St Josephs Medical Center, Tacoma
pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


Never ceases to amaze me how much these other specialties care about the well being of our patients....

It is not unheard of to use a medical instrument in more than one body cavity. Gastroenterogists sometimes perform enteroscopies, an upper endoscopy in which the go past the ligament of Treitz.  They do sell dedicated enteroscopes but the cost may not be justified, as these are not performed routinely.  So guess what they use, colonoscopes!  Endoscopes are not long enough.

No special cleaning is performed to use the colonoscope through the mouth.  High level disinfection (as is performed in endocavitary probes) is all that is done. Find out if your GI docs are doing this, if they are, end of argument, you can do it 3-4 times a year too.

Manny

Manuel A. Colón García de la Noceda, MD, RDMS, FACEP
Assistant Professor
Emergency Ultrasound Coordinator
University of Puerto Rico
pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


We use probe covers and the radiology department handles the deep cleaning after every use. It's never been an issue.

Robert R. Cooney, MD, MSMedEd, RDMS, FAAEM, FACEP
pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


 It is really ridiculous.  I agree with the colonoscopes.  Too bad Olympus didn't figure that out sooner.  Several deaths related to infections passed on.  BUT, those probes are always covered since no lenses are involved.  No sharp things in the vagina to tear the probe condoms!?

 

Robert Nakamura, MD


pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


This is truly a sickening situation.

Why do you have to answer to a diagnostic imaging director ?  Does that person have control over all imaging in the hospital ? If so, this needs to change.  I would suggest reviewing your hospital bylaws and making sure there is no malignant language in there that states radiology controls all imaging within hospital.  

I would arrange meeting with hospital admin and your chair and discuss the issue.  I'm sure hospital would be interested in hearing about a diagnostic test that has been shown to reduce length of stay, radiation and overall cost. Oh and by the is safer for the patient if used for procedural guidance for PTA.  Your "DI" is inhibiting quality and safe patient care by his actions.

I don't think this is the first problem you are going to have if this "DI" has oversight over point of care at your shop. Hope this helps and good luck .


Rajesh Geria MD
Past Chair, ACEP Ultrasound Section
pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


It’s hard to beat  the human mind for the ability to passionately embrace 2 or more mutually inconsistent or contradictory notions.  IN addition to the examples already noted, how come the standards for  “safe” use of the petri dish of the human hand is so different from that advocated for the dry, cleansed, bacteriologically inhospitable surface of an ultrasound probe?   Physicians routinely perform  a pelvic exam (or oral exam – site of the highest and most varied bacteriological load in the body) with nothing but a pair of disposable gloves (1-5% failure rate), followed by a simple hand wash (thank you Dr Semmelweis) before examining the next patient.  Nary a wipe down with chlorox solution or 15 minute soak in Cidex!
 
Regardless, in our squeaky-clean culture, rational argument barely gets a look-in once someone starts yelling “fire” about putting an object in “that patient’s vagina” and subsequently in “my, my family member’s, or my patient’s mouth”, even if you used 10 impervious probe covers, and cleansed it in a nuclear reactor.
 
Obviously you have to fight this , but reason vs. emotion is always a tough battle.  Good luck.
Aj
 
 
 
Anthony J. Dean, MD, FAAEM, FACEP
Associate Professor of Emergency Medicine and Associate Professor of Emergency Medicine in Radiology
Director, Division of Emergency Ultrasonography
Department of Emergency Medicine
University of Pennsylvania Medical Center
pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


2 easy studies for residents we can do to address this specifically.

1. Culture the outside of some clean empty ultrasound condom covers and culture the outside of the same types of covers on endocavitary probes after they have been cleaned in your department. Look for any difference.

2. Culture the endocav probes directly once pulled out of cleaning solution and dry. See if anything grows.

We've got the forum to make it a multicenter, possibly international study, and increase the n.

Anyone interested email me back. Ideally publish in a journal. Maybe just put the data on acep website. With some direct data on this, the section could make a formal statement/recommendation. Maybe we'll silence the critics. Maybe we'll be surprised and need to adjust practice.

Clark Rosenberry MD FACEP
EP, several hospitals in KS
pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


 I have been hearing more stories lately about pushback from radiologydepartments regarding point of care studies. From the aunt Minnie "study" recently discussed on the listserv, to this story. This past week, a hospital I know of (not mine), had bedside ultrasound studies by EPs briefly suspended by the hospital. This came after a first trimester patient refused a transvaginal ultrasound by radiology. She had received a bedside TA and TV ultrasound where the EP could not confirm an IUP and sent the patient to radiology. After significant ED pushback, bedside US priveleges for EPs were restored.
This got me thinking that it would be great to have a document on the listserv which contains a reference list of society guidelines and studies supporting bedside ultrasound, which can be used if, and when, we need to fight for our priveleges (AKA, the good fight). If the section thinks this is worthwhile, I would be happy to create the document.

 

Joshua Guttman, MD


pererap
Posted: Sunday, August 2, 2015
Joined: 8/31/2011
Posts: 231


After the previous concerns raised about endocavitary probes, I did a lit review on the data available. Sounds like high level disinfection techniques are only way to go. I've attached my brief review for your enjoyment. References are there if you want to delve further. Feel free to share or discard.

Clark Rosenberry, MD FACEP
File Attachment(s):
Use HLD for endocav probes.doc (37888 bytes)

 
Feedback
Click here to
send us feedback