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R: ULTRASOUND digest 530From: Dr. Stefano Ciatti (studiociatti@iol.it)Mon May 3 13:36:51 1999
>From jworrall@alaska.net Mon May 3 13:36:51 1999 Received: from calvino.alaska.net (root@calvino.alaska.net [209.112.130.6]) by talk.obgyn.net (8.9.3/8.9.3) with ESMTP id NAA12594 for <ultrasound@obgyn.net>; Mon, 3 May 1999 13:36:50 -0500 Received: from delloffice (159-p53.fbk.alaska.net [209.112.151.159]) by calvino.alaska.net (8.9.1/8.9.1) with SMTP id KAA26110; Mon, 3 May 1999 10:36:45 -0800 (AKDT) Message-ID: <000601be9593$f08a9e20$9f9770d1@delloffice> From: "Joseph A Worrall MD RDMS" <jworrall@alaska.net> To: <ultrasound@obgyn.net>, "Multiple recipients of list ULTRASOUND" <ultrasound@talk.obgyn.net> References: <fc.00663c65001c83953b9aca007b3e528f.1c83fc@jackson.cc.mi.us> Subject: Re: ULTRASOUND digest 530 Date: Mon, 3 May 1999 10:37:01 -0800 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Here is how I do it: You will need a sterile single-hinged speculum, Betadine, sterile sponge forceps, cannula (I use the Goldstein), short connecting tubing, and 60 cc syringe filled with sterile saline. Make sure all the system is flushed with the saline, and all possible bubbles are out. You will also need sterile gloves. I don a nonsterile glove, and insert the speculum. (If appropriate make sure she is not pregnant). Clean the vagina and cervix with Betadine. Don sterile gloves (the nurse has already made up a sterile tray with all the stuff on it, and the system flushed with saline) and insert the cannula about 3 cm. (Have some small sterile dilators handy in case there is a cervical stenosis and you have to dilate the canal). VERY CAREFULLY remove the speculum (do not accidentally pull out the cannula!) and insert the transducer. When you have a nice sagital image of the endometrium, have the nurse inject a few ccs of saline. In most patients there is no trouble in getting the cannula in the uterus. In most patients the water runs out of the uterus slowly enough that you can see what you have to see. In a rare patient the water runs out as fast as you put it in, and you cannot distend the cavity. In that case I use a little cannula with a balloon. Why don't I use the balloon catheter in the first place? Because it is much more expensive that the straight catheter, and it is rarely needed. About two ccs of air or saline is all it takes in the balloon, then gently pull the balloon down against the internal os, then inject the water into the endometrial cavity. Of course the water eventually runs out of the vagina, so have some pads under the patient. I presume that a sonographer would not be expected to insert the cannula, dilate the cervix, etc, so probably all the sonographer has to do is have the setup ready, and handle the ultrasound machine. I would also presume that if a radiologist or gynecologist did the intrauterine part, that he or she would also handle the transducer, but maybe not. I do the entire thing myself, with, of course, the invaluable help of my nurse. It is a simple and very helpful procedure, and usually very easy to do. Joseph A Worrall MD RDMS
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