Re: US guided procedures
From: lindad1@netnitco.net
Fri Oct 6 20:43:01 2006
Dr. Smeltzer;
After prepping a patient with betadine; why wouldnt you just use a
pre-packaged sterile probe cover that already has a packet of sterile gel in
it - we use that our facility for all ultrasound guided invasive procedures
and to date have not had complications. The pre-packaged sterile probe
covers and sterile gel are relatively inexpensive and there is less chance
for contamination because the individual scanning puts the [probe cover on
with sterile gloves and continues with sterile technique throughout the
procedure.
Respectfully;
Linda Dipiazza RDMS<RVT
>----- Original Message -----
From: "James Smeltzer" <James.Smeltzer@wellstar.org>
To: "Multiple recipients of list ULTRASOUND" <ultrasound@dns.obgyn.net>
Sent: Wednesday, October 04, 2006 11:34 PM
Subject: Re: US guided procedures
> Hi!
>
> Sterile gel should be used outside a sterile gloved transducer in the
> assistance of a sterile (invasive) procedure. Non-sterile gel does not
> only not kill bacteria, it protects them from a disinfecting agent,
> such as an iodophore. Any contact with a "sterile" instrument or needle
> contaminates the procedure, and introduces an unnecessary risk of
> infection.
>
> I had two infection-related fetal losses in about 500 procedures in the
> first two years of practice - with non-sterile gel that was supposed to
> be away from the needle. I then abandoned this "assistance" in 1986 for
> a two hand sterile technique with a gloved transducer (the gel needed
> inside the glove need not be sterile) - the same one I use and teach for
> intrauterine transfusion - and have had no unexpected (normal fetal
> phenotype and growth) losses since.
>
> A good friend and referring physician almost lost an Rh negative son to
> infection related to (unnecessary) serial amniocenteses (using
> non-sterile gel) for bilirubin (by another practitioner), for a baby who
> turned out to be (and could have been discovered to be by DNA testing of
> the first specimen) Rh Negative.
>
> Sterile gel is expensive but it is usually unnecessary. I have
> sometimes used it for LOOONG procedures, such as fetal surgery,
> therapeutic amniocentesis and intrauterine transfusion. I usually do
> not use it in these circumstances either.
>
> The best medium is the iodophore. It is sterile, kills bacteria,
> provides good images and persists for an adequate time for most
> percutaneous procedures. I dab some more on with a sponge for long
> procedures when it dries out. I do use sterile gel with alcohol for
> those allergic to iodine, as the alcohol evaporates too rapidly to use
> as a contact agent.
>
> This is a personal opinion, based on decades of good technique, or good
> fortune. Sterile gloves are fairly cheap, as is iodine.
>
> Hope this helps!
>
> Jim S
>
> James S. Smeltzer, MD, FACOG, SMFM
> Consultant, Maternal Fetal Medicine
> Wellstar Physicians' Group
> Northwest Women's Care
> 787 Campbell Hill St
> Marietta GA 30060
> James.Smeltzer@wellstar.org
> VM 678-290-3035
> Off 770-528-0260
> Page 404-318-3451
>
>>>> HowM <jendela@klinikfoo.com> 10/3/2006 8:45 AM >>>
> Hi Dr Udayakumar and Professor Terry J. DuBose,
>
> During US guided procedures, is it necessary to use STERILE gel ?
> STERILE gel is more difficult to come by and it is expensive.
>
> MHFoo
> Malaysia
>
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