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13 Ultrasound Equipment Maintenance
Fig. 13.6 Choosing your equipment: assess control surface layouts, user interfaces, and overall
ease of use. Look at how transducer cords are managed, how easy the control surfaces are to clean,
ease of cart mobility, are there locations for supplies that you will want on the cart?
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User Education andOrientation Is Essential
A new ultrasound machine can cost as much as a small used plane or boat. No one
should use the machine until they can demonstrate an understanding of proper start up and shut down procedures, transducer selection, and image optimization. Most
importantly, prospective users must be trained in the proper handling and storage of
transducers (the most expensive part of the machine that is most likely to get broken). Education in proper care of your transducers is key. “In your hand, in the cup
holder, or on your VISA” can be a useful mantra to instill appropriate user respect
for transducer care and it will simultaneously remind your users to never leave an
unsecured probe on a bed or tray table surface. Finally, all users need to demonstrate
an understanding of proper cleanup procedures for transducers, cords, and control
surfaces after use. Users should know where to return the ultrasound equipment
after patient use, with all cords tidied and equipment plugged in for recharging.
Education in equipment orientation and machine care should be included in all
introductory US lectures.
Find aSafe Harbor
You will need to designate safe storage areas for your ultrasound machines when
they are not in clinical use. Your equipment should be easy to locate by the clinician
when needed and should be parked in a safe location where it can be plugged in for
recharging and avoid getting prematurely dinged and broken. Lobby for front and
182
A. Dewitz
center space that is convenient for the providers who will be using this equipment
many times a day. Do not allow your equipment to be relegated to a back corner of
your ED or other clinical care setting. Make sure you obtain appropriate signage to
mark the storage areas and train your users and medical workers to return the ultrasound equipment to its designated home port when not in use. If you have multiple
storage areas, label your machines with directions as to where the machine should
be returned when done. Make sure to have your hospital electricians install the
charging outlets at waist height for ease of use for the many providers who will be
plugging the machines in and out many times a day.
Provision fortheJourney Ahead
Streamline and automate the supply and distribution process as much as possible.
Regular stocking and distribution of numerous ultrasound supplies will be
required for smooth program operation. Enlist the support of your ED/ICU or
clinic manager, and get your nursing staff and medical workers involved. Typical
ultrasound supplies needed for a busy ED ultrasound program will include: a gel
warmer in each patient care area, LOTS of US gel (this can add up to many hundreds of bottles a year), probe disinfection solutions or wipes, thermal print paper,
squeezable gel- proof skin markers that will facilitate your many map-and-mark
US procedures (Fig.13.7). Since you will most likely also be using your machines
for placing ultrasound-guided peripheral IVs in your difcult access patients, you
will need a steady supply of sterile adhesive dressings, sterile probe covers, appropriate length needles for US-guided PIV access, chlorhexidine skin wipes, tourniquets, sterile surgical lubricant, catheter securing systems, and benzoin swabs,
ideally all stocked and stored on your ultrasound cart for ease of use (Figs.13.8
and 13.9).
Equipment cleaning and routine equipment maintenance is an unglamorous but essential component of your US program operation that cannot be overlooked. Day-to-day equipment care and oversight, as well as a host of preventive
maintenance issues will need to be regularly attended to, some weekly, some
monthly, some biannually. Day-to-day care includes routine cleaning of control
Fig. 13.7 Typical supply needs include US gel, gel warmers, low level disinfection sprays or
wipes, thermal print paper, gel-proof markers for your “map and mark” procedures
13 Ultrasound Equipment Maintenance
Fig. 13.8 US-guided PIV access supplies: sterile adhesive dressings, 48mm and 64 mm needle
options
183
Fig. 13.9 Tray table layout of all the supplies needed for USG PIV line insertion: blood draw
setup and tubes, spiked IV setup, tourniquets, non-sterile gloves, sterile adhesive dressing for
probe cover, Chloraprep skin wipes, sterile surgical lubricant for US gel, (lidocaine and TB syringe
optional for skin anesthesia, if needed), correct length US PIV needles, 48 and 64mm, (NO standard 30mm Angiocaths), gauze for skin cleanup after the line is placed, Chloraprep to remove any
remaining gel/blood that may impede adhesion of the dressing, Benzoin swabs for added dressing
adhesion success, sticky foam IV securing device or equivalent, nal sterile adhesive dressing
placed over the foam dressing to help prevent accidental line dislodgement
surfaces, inspection of transducers, transducer cords and power cords, cart cleanup
after unanticipated exposures, as well as gel distribution and inspection of what
needs restocking on the carts. Routine maintenance and cleaning seems to fall
disproportionately onto US section staff unless you plan wisely. Enlist your ultrasound rotators, medical students, residents, and your faculty to help you, but
above all, advocate for dedicated medical worker or ED manager time for these
essential tasks. A maintenance checklist can be useful if you have many machines
to care for and can provide an organized system for keeping track of which items
will need attention or repair on which machines (Fig.13.10).
184
ED Ultrasound Equipment Checklist
Service Contact Name:
Phone:
Make/Model:
Serial number:
Transducers on cart:
Serial numbers:
Ancillary cart
equipment:
Maintenance Schedule:
Control deck, transducer cup holders and cart
clean?
Transducers checked and clean?
Midline marked?
Trackball/trackpad clean and working?
Transducer bungees correctly positioned?
Control knobs damaged?
Wiring and plugs checked?
Any parts/attachments loose?
Control deck labels intact?
Filters and fans cleaned?
Supply baskets stocked?
Cart wheel lubrication/cleaning needed?
Endocavitary probe cleaning station functioning?
Gel warmers stocked?
Printer with paper and functioning?
Group e-mail reminder?
Anything else?
A. Dewitz
Email:
Fig. 13.10 US equipment checklist
What follows are some of the ultrasound equipment maintenance issues that you
are likely encounter and will need to attend to.
Most day-to-day disinfection will be accomplished with a topical disinfectant
spray such as T-Spray, Pi-Spray, or chlorhexidine disinfectant wipes on the probes
and control surfaces. Isopropyl alcohol soaked gauze can be used on the cart body
(A more detailed review of probe disinfection is discussed in another chapter)
(Fig.13.11). Transducer storage cups will inevitably become a repository for dust
and dried adherent ultrasound gel and they will need regular (at least weekly) cleaning. A short bottlebrush purchased in any hardware store comes in handy for cleaning these transducer cup holders very efciently, and will be particularly useful if
13 Ultrasound Equipment Maintenance
185
Fig. 13.11 Products for daily cleaning of the US machine
you have a lot of machines to maintain. The large Q-tips that you might carry on
your OB/GYN cart may also be used for this purpose (Fig.13.12).
Inspect your transducers and transducer cords for defects and cracks. You should
not be using transducers with cracks on the scan head or splits in the housing or cord
cover. If you nd such defects you need to make arrangements to have the transducer replaced (Fig.13.13).
Set up an equipment maintenance supply bucket and stock it with products you
will need for tackling the various mystery uids and adhesive assaults your machine
will inevitably encounter. Useful agents include hydrogen peroxide for dried blood,
isopropyl alcohol, bleach wipes, or general-purpose spray surface cleaners for cart
body cleaning (Fig.13.14). Do not use isopropyl alcohol to clean your transducer
cords. You will additionally need to purchase a non-acetone based adhesive-removal
solvent like Goo Gone or Goof Off. There isn’t much else that will safely remove the
adhesive goo that will inevitably mar your control surfaces, cart body and cart wheels.
Adhesive foam EKG electrodes, foam IV securing devices, remnants of patient labels,
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Fig. 13.12 A short bottle
brush or GYN Q-tips work
well for cleaning out dust
and gel from transducer
cup holders
A. Dewitz
13 Ultrasound Equipment Maintenance
Fig. 13.13 Transducers with visible defects such as these will need to be replaced
187
Fig. 13.14 The US eet
cleaning and maintenance
supply bucket, ready for
any eventuality
188
A. Dewitz
and dried benzoin splashes (most vexing!) appear to be the most common offenders;
hopefully no one is sticking used bubble gum under your deck! Do not be tempted to
use the acetone nail polish wipes you might have in your ED for this purpose. Although
they will successfully remove adherent adhesive items or residue, they might also dissolve and irrevocably mar the plastic surfaces of your cart or control panel in the
process! (Fig.13.15). Periodically oiling the wheels of your US cart can help keep
them gliding smoothly, and a can of compressed air comes in handy for cleaning out
dust in any fan openings and in the TGC nooks and crannies if you have an older
machine with button-based TGC controls (Figs.13.16 and 13.17).
What should you do when you show up to a shift and nd a blood-spattered
machine, blood on the transducers and cords, or if you frequently encounter dirty
transducer probe covers that have not been removed after use? (Fig.13.18). Repetitive
maladaptive behaviors need to be addressed and should merit the occasional group
e-mail and photo reminding your staff members of their equipment cleanup obligations after any ultrasound-guided procedure or after the evaluation of a bloody trauma
patient. Periodic “public service announcement” reminders during your US conferences can also be helpful to inculcate good equipment cleanup habits and establish a
culture of shared responsibility for US equipment cleanliness. You will additionally
need to periodically remind your staff that the ultrasound control panel is NOT to be
Fig. 13.15 Essential adhesive-removal solvents that will be needed for equipment cleaning; no
acetone!
Fig. 13.16 Caster wheels
will roll more smoothly
with occasional oiling
13 Ultrasound Equipment Maintenance
189
used as a storage surface for coffee, used intubation blades, and random supplies
being distributed about the ED or ICU (Fig.13.19). A spilled cup of coffee on an
unsealed ultrasound control panel can turn into a very costly misadventure. Start
your group e-mail with the gentle subject line “It takes a village….”
If you have an active ultrasound training program and multiple ultrasound
machines in use, you will likely nd yourself using prodigious amounts of ultrasound gel (Fig.13.20). Outsource this stocking and distribution task if you can, as
it can add up to many hundreds of bottles to distribute each year. Although buying
your ultrasound gel in 5L bulk containers is cheaper, it is safer to stick with prelled
bottles since bacterial contamination with Pseudomonas and Klebsiella and Staph
species has been reported to occur from relling used ultrasound gel bottles. Other
Fig. 13.17 A can of compressed air will help clean out dusty TGC buttons on older machines
Fig. 13.18 The wall of shame: your staff will need periodic reminders of their responsibility to
remove used probe covers and clean the machine after a messy trauma room encounter
190
Fig. 13.19 The US control panel should not be used as a storage surface; strongly discourage such
behaviors
A. Dewitz
Fig. 13.20 Place a gel
warmer in each patient
care area and make sure
you have easy access to
extra gel for restocking