Emergency Ultrasound

Peter’s Pet Peeves: Ultrasound Hygiene

Peter Kumasaka, MD

“!#$@*&$%^!”. Yes, I have been known to utter more than my fair share of F-bombs, but some things make me go on a blitzkrieg. Bombarding the whole ED. Without concern for any collateral damage from my tirade, I rant on. “John Effen Jingleheimer Schmidt!”

What upsets me so much? See the two pics below.

US Hygiene1 US Hygiene2

Who could leave the probe smeared in blood (or fluid from some bodily orifice)? Meanwhile, does anyone really think that a $2 bottle of gel is more important than a $10,000 linear array probe? Or why leave it unplugged, letting the battery drain dead? Now it won’t turn power on for that hypotensive patient in room 3!

I remember coming home after a busy day of work and stumbling over my 6 year old son’s shoes. He came home and flung them off, letting them land wherever they may. Typically, right in the middle of the hallway, where I could trip on them, and break my ankle. I needed to fix this, so I whipped up a couple of days of &$%! sandwich feedback. (Criticism sandwiched between two slices of praise.) “Hey Owen, you’re reading really well. But you need to put your shoes away and not leave them in the middle of the hall. But, I’m what I am really proud of, is that you are not missing the toilet any more!” Three days later, shoes are neatly placed in the rack and no broken ankles.

So how come these adults can’t learn to clean up and take care of their own “shoes”? Why are the machines getting dirty like this at all? How come we aren’t using a probe condom? You know, “No glove, no…scan”. Yes, you can use an actual glove to keep the various body fluids from soiling the machine.

Well the &$%! sandwich hasn’t worked. The open faced &$%! sandwich hasn’t worked. Now it is time for the Atkins diet. And still…

Believe me, it is not just a matter of raising my ire that the ultrasound is messy and dirty. What do you think the patient or family is thinking when you roll a filthy ultrasound into the room? “You are NOT going to put that probe on me!” The machine is now a petri dish when soiled. A veritable wheeled vector of disease. Or a space occupying mass when the probes are broken or the battery is dead.

We have to lobby the C level administrators to purchase these expensive tools that can really make a difference in the quality and timeliness of patient care. The use of ultrasound can positively impact the connection and communication that we have with the patient and family. But if we don’t take care of them with simple measures, they will break down and our C Level parents won’t want to buy us kids any more “toys” that we don’t know how to take care of. Patients and families won’t have confidence in us or our care when we bring in broken down, soiled machines that don’t work, or look like (and probably can) make them sicker. Primum non nocere. First, do no harm.

We need to be better about getting EVERYONE in the department to take ownership of these incredible tools so that they can be used for good and not evil. We all need to grow up and clean up after ourselves. We can also pick up after each other when we see something and not just walk by the unplugged machine with blood on it. Stoop over and pick up that piece of litter on the ground, that shoe in the hallway. Maybe you’ll prevent someone from tripping and breaking an ankle. Maybe it is your own shoe.

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