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Re: US guided procedures From: James Smeltzer (James.Smeltzer@wellstar.org) Wed Oct 4 23:32:23 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: JOE ANTONY : "Stuart Campbell Op-Ed" Previous message: HowM: "Ultrasound use in Primary Care" In reply to: HowM: "US guided procedures" Next in thread: lindad1@netnitco.net: "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 <<<<<<<<<<Confidentiality Disclaimer>>>>>>>>>> This email and any files transmitted with it may contain confidential and /or proprietary information in the possession of WellStar Health System, Inc. ("WellStar") and is intended only for the individual or entity to whom addressed. This email may contain information that is held to be privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any unauthorized access, dissemination, distribution or copying of any information from this email is strictly prohibited, and may subject you to criminal and/or civil liability. If you have received this email in error, please notify the sender by reply email and then delete this email and its attachments from your computer. Thank you. Next message: JOE ANTONY : "Stuart Campbell Op-Ed" Previous message: HowM: "Ultrasound use in Primary Care" In reply to: HowM: "US guided procedures" Next in thread: lindad1@netnitco.net: "Re: US guided procedures"

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