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LIN Sessions – Ultrasound Guided Peripheral IV and Sterility

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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EMRAP 2019 01 January Written Summary 302 KB - PDF

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Justin G. -

I have heard that Sani-clothes can damage the ultrasound probe. Is this correct? What is the best method to clean the probe?

JMV -

Every ultrasound manufacturer has a compatibility chart for their systems/probes. We use Sonosite X-portes in our ED's. For low level disinfection, we use Sani-cloth with the gray tops.

JMV -

One question I have is regarding the use of Tegaderm. Comment made in segment that the pore size will not block viruses such as HPV, HIV.
However the 3M website says this about Tegaderm...

*In vitro testing shows that the transparent film of 3M TM TegadermTM brand dressings provide a viral barrier for viruses 27 nm in diameter or larger while the dressing remains intact without leakage.

Thank you.

Ronald R. -

I found this same information while doing my research. Im wondering if the use of "tegederm" is a gloss for all IV dressing covers, not realizing that 3M makes a trademarked product called tegederm which has a much smaller pore size than is discussed in the broadcast?

Steve D. -

On the ALiEM blog, there's mention of using a non-sterile glove to protect the probe. Would that also work?

Dan M. -

Thank you everyone for your interest in this topic and for listening in.

Justin G. - We have Mindray M9's and use Gray top wipes. I agree with JMV's statement about compatibility charts.

JMV and Ronald R. - You are correct. In looking into this, it appears I was wrong. The secondary source I quoted noted 100nm while this primary source is likely more accurate. Others can see it here... https://bit.ly/2Hk4twg My apologies for purporting inaccurate information.

Steve D. - Yes, a non-sterile glove is fine and is now my preferred cover. AIUM updated their guidelines on 11/3/2018, after the EMRAP episode was recorded. They now state, "The level of transducer cover sterility is dictated by the level of procedure sterility. As examples, clean procedures requiring nonsterile transducer covers include peripheral vascular intravenous line placement." You can see their complete statement here... https://bit.ly/2FpJx5k

Thanks again and I look forward to further discussion!

Dallas Holladay, DO -

I feel like the Tegaderm pore size issue needs an on air correction. This was the largest argument against using Tegaderms for USGIVs and it is incorrect. The lens damage issue can easily be avoided by using gel between the Tegaderm and the probe.

Alison D. -

We use the "red" Sani-cloths to clean our Zonare probes used for peripheral IVs. These report to kill the viruses of concern (HIV, HCV, HBV, etc). What additional benefit is there, in that case, to using a probe cover for that specific application?

Jacob P. -

We have a sheath very similar to the standard full sterile CVC cover that is only about 30 cm long and comes packaged non-sterilely. Much less packaging than a sterile probe cover, small enough that it handles like an uncovered probe, but still described as anti-viral.

Frustratingly, my only description of the specific item we use is through our supply folks and I have been unable to find a web description of the exact item. That being said, we’ve found what we consider to be an acceptable middle ground between a full sterile probe cover and a tegaderm, and it has worked very well for us.

Gregory Z. -

Can the chapter author address the above concerns? Stating the pore size of Tegaderm 22000nm is not supported by any citation. Additionally as others have alluded to above, the Tegaderm supplemental material states pore size of 27nm. This size should theoretically stop all the viruses in which we are clinically concerned.

Given the controversy this segment has caused, this needs to be clarified.

Dan M. -

Gregory Z. - You are correct. I was wrong regarding the pore size of Tegaderm films. The secondary source I used was incorrect while this primary source is more accurate; citing 27nm. Others can see it here... https://bit.ly/2Hk4twg
My sincere apologies for purporting inaccurate information. I still maintain that Tegaderm-like products are a suboptimal solution to this problem due to the potential of the adhesive to void the machine warranty and the newly revised AIUM guidelines as noted in my Jan 19th comment.

Christian M. -

I'm a bit confused why the anti-sepsis standard for a US probe is so much higher than anything else we use. Hep B infected blood gets on all kinds of places and we are not autoclaving that stuff, as the authors suggest. Hep B is killed quite easily by anti-septic wipes with alcohol, which should be common sense and routine to do after any sort of procedure.

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EM:RAP 2019 January Full episode audio for MD edition 226:18 min - 211 MB - M4AEM:RAP 2019 January German Edition Deutsche 103:05 min - 142 MB - MP3EM:RAP 2019 January Canadian Edition Canadian 27:18 min - 38 MB - MP3EM:RAP 2019 January Spanish Edition Español 80:39 min - 111 MB - MP3EM:RAP 2019 French Edition Français 20:32 min - 28 MB - MP3EM:RAP 2019 January Aussie Edition Australian 0:44 min - 1 MB - MP3EMRAP 2019 01 January Board Review Answers 125 KB - PDFEMRAP 2019 01 January Board Review Questions 302 KB - PDFEMRAP 2019 01 January Individual Written 655 KB - ZIPEMRAP 2019 01 January Written Summary 302 KB - PDFEM:RAP 2019 January Individual MP3 Files 204 MB - ZIPEM:RAP 2019 January Spanish Written 803 KB - PDF

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