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13 Ultrasound Equipment Maintenance
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ultrasound coupling agents have been touted to be equally effective and less messy; in the future, we may be using small amounts of a residue-free ultrasound coupling liquid applied with a cloth just prior to scanning.

US Machine Cleaning

(See Chap. 15 – Safety and Infection Control for probe cleaning)

Preventive Maintenance

This is somewhat machine dependent but may include any or all of the following:
Basic Toolkit
Invest in a basic multipurpose toolkit that includes slotted and Phillips screwdrivers, and an adjustable wrench so you can tighten up some of the common trouble spots on your carts. Many ultrasound machines will use Torx type screws, so a folding Torx wrench may come in handy. Common cart trouble spots include cart housing screws, power cord attachment sites, and wheel assemblies. Having a few basic tools available will allow you to attend to some of these machine specic problems yourself (Fig.13.21).
Fig. 13.21 It is helpful to have a basic equipment repair toolkit for some of the cart items that you will periodically want to adjust or tighten up yourself. Many carts use a Torx based system
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Cleaning theTrack Ball
You can learn how to do it yourself or have it done during semiannual preventive maintenance visits. Why bother? The internal trackball mechanism gets coated with US gel over time impairing its function. A track pad or touch screen panel avoids this problem altogether (Fig.13.22).
Fig. 13.22 Trackballs need periodic cleaning to remove ultrasound gel that can impede smooth trackball function
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Filter andFan Care
The ED is a VERY dusty place. Many ultrasound units have dedicated power sup­plies with cooling fans and lters to keep the electronics from overheating. Ideally these lters should be cleaned every few months. Waiting for a biannual or annual preventive maintenance visit is often inadequate and the lters may be clogged up by then. The lters need to be removed, washed with soap and water, then dried and replaced. If you don’t clean them, the fans will no longer function efciently, and your electronics can overheat, give you error messages or crash your equipment software. Any piece of equipment in your clinical care setting that has an onboard cooling fan running will inevitably vacuum up lots of ever-present dust. This is yet another reason why we should not leave our ultrasound machines running when not in use (Fig.13.23).
Fig. 13.23 The ER is a very dusty place. Onboard lters should be cleaned every several months to avoid overheated electronics. Once a year cleaning is inadequate
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Fig. 13.24 A VCR head cleaner will help maintain good quality video images if you are still using this type of image storage medium
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VCRs/CD Recorders
Not a lot of people are still recording ultrasound images with videotape, but if you still use this medium for image review, your VCR’s image quality can be improved by using a $5–$10 tape head cleaner every few months (Fig.13.24). Digital image capture devices like CD recorders simply need a periodic cleaning of the control surfaces and a periodic check of their plugs and connectors.
Tighten theLoose Stuff
Problem spots are machine specic. Your biomedical engineering folks or your equipment repair tech can point out what gets attended to on a routine preventive maintenance visit. Power cord holders on some older machines need monthly atten­tion to keep them from loosening and falling off due to the heavy forces placed on them.
Broken Control Surface Buttons
Older machines often have plastic buttons that dry out and crack after having been T-Sprayed a few thousand times; TGC control buttons seem to be the rst to break down. You can order a bag of replacement buttons and knobs from your ultrasound equipment vendor and with a bag of replacements handy you can address these small annoyances yourself (Fig.13.25).
13 Ultrasound Equipment Maintenance
Fig. 13.25 Buy a bag of new buttons for your older machines so you can replace them when they break
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Ultrasound Cart Wheel Assemblies
The plastic wheel housings on some ultrasound carts are poorly designed for the rigors of clinical use and will predictably loosen and fall off. This is mostly a cos­metic issue. The plastic housing simply hides the fact that the wheels get mightily gunked up over time, usually with a combination of dried blood, EKG electrode stickies, foam IV securing devices, tape of various sorts, and unbelievable amounts of hair! (Fig.13.26). When your cart starts to shimmy or be noticeably difcult to roll around, it is time to give the wheels some attention. Ultrasound cart wheel assemblies need periodic cleaning and oiling, removal of the many adherent adhe­sive items with a solvent like Goo Gone or Goof Off, and the occasional haircut (forceps and scissors work best, high and tight!). The foot controlled wheel locking switches get very dirty over time but can be easily cleaned with any general-purpose spray cleaner and a bristle brush or old toothbrush. Seriously unglamorous stuff (Fig.13.27).
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Fig. 13.26 Cart wheel woes that you will inevitably need to address: cracked housings, glued on EKG electrodes, dressing materials, foam IV securing devices, and more hair than you can imagine
Fig. 13.27 Cart wheel cleaning: soak and brush off the foot pedals, forceps and scissors for the haircuts. Wear gloves!
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Fig. 13.28 Power cord plug end woes: bent pins, a cracked housing, exposed wires: all bad, time for replacement
Wiring Check
Power cord plug ends take lots of abuse. The machines get plugged in and out many times a day, 365days a year, and occasionally the cord will take an extra whack when people move the ultrasound machine having forgotten that it is still plugged in. When the plug pins get bent, if the plug end housing is cracked and has wires peeking through anywhere, or if the power cord has nicks in it from being run over a few too many times it is time for repair or replacement (Fig.13.28). It can be help- ful to have a backup power cord on hand. If you just need to replace a bent plug pin that you can no longer straighten, you can have your hospital electrician install a new hospital grade plug end (Fig. 13.29). Periodically you should also visually inspect the power cord for nicks and defects in the housing.
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Fig. 13.29 The famed “Hospital Grade” plug
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Ideally, a well-designed machine should have all important wiring hidden and protected within the cart or housing. This is rare with older machines in particular. Important but exposed wiring can get disconnected. Velcro cable ties (1/2×6in., purchased at any hardware store) can be used to help neaten up this clutter and can help keep your equipment wiring tidy and out of harm’s way.

Customizing

Customizing your new ultrasound equipment to suit your specic practice needs is an essential and fun part of the process of getting your machine ready for use in your clinical setting. Even after many years in the business and many (14!) machine pur­chases later, I have yet to see an ultrasound machine that didn’t benet from cus­tomization and modications to make it more user friendly and better suited to our ED practice setting. All our ultrasound machines start out their lives in the Ultrasound Section “Chop Shop” (our Ultrasound Section ofce) before they get launched into the ED.If you buy several machines at a time you can do them up in bulk.
Essential Supplies
So what are the essentials? You’re going to need some 4×2″ industrial Velcro strips, ¾ Velcro sticky-back tape, ¾×8 Velcro cable ties, plastic cable ties, metal extension springs or Kevlar/polycarbonate retractable key fobs, coiled plastic key rings and clips, and some metal key rings (Fig.13.30).
13 Ultrasound Equipment Maintenance
Fig. 13.30 Essential customizing supplies for new machines include: industrial and regular Velcro sticky-back tape, Velcro cable ties, plastic cable ties, piano wire extension springs, coiled key, metal key rings, and robust key fobs
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Transducers andTransducer Cords
Implementing a system to protect your transducers and transducer cords will be your number one customizing task. Surprisingly little attention has been paid to this issue by ultrasound vendors, likely due to the fact that historically, ultrasound carts were mostly parked in one location and the patient was brought to that location for imaging. Most older ultrasound machines were very poorly designed for high mobility applications. Newer point-of-care machines and carts are much better designed in terms of footprint, wheel assemblies and simplied keyboards, but they are still mostly lacking in good transducer cord management solutions. At 4000 to over 10,000 dollars each times three to four transducers on each machine, you have a big incentive to protect these most essential and pricy parts of your ultrasound eet. If your transducer cords are not properly secured it is almost guaranteed that you will at some point in time nd a transducer cord snugly wrapped around one of your ultrasound cart’s caster wheels (Fig.13.31). While this will predictably cause you severe agita and might even bring the occasional tear to an ultrasound director’s eye, it is an entirely avoidable event.
Transducer trauma can be likened to neuro trauma. For the transducer head, the closed head injury model applies. You drop it, your crystals get damaged, and things
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Fig. 13.31 A transducer cord wrapped around a cart caster wheel; guaranteed agitation
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are never quite the same thereafter. User education on proper transducer care is the best preventive medicine to keep this type of trauma from occurring. Users should be taught from the outset that the transducer is very expensive, somewhat fragile, and should always be protected. There should be zero tolerance for laying the probe on a stretcher, a tray table, or on top of the ultrasound machine. “In your hand, in the cup holder, or on your VISA” is a useful mantra for inculcating good transducer care behaviors.
For the transducer cord, the spinal cord injury model applies. An unsecured transducer cord will drape onto the oor, and will at some point inevitably get run over and caught in the cart’s wheel assembly. As a result, the cord housing may be violated, some essential wiring may have been severed, and the transducer rendered less than optimal, possibly useless. For this issue there is a simple x: don’t let the cord ever hit the oor.
Transducer and transducer cord protection can take on many forms. Years ago I had our hospital welder build a stainless steel cage for cord storage on a “mobile” 285lb machine that was probably originally designed to just sit it one location and not be moved around a lot. (But what a good workout we got every shift!) The idea of a transducer cord bungee system began many years ago when Dr. Anthony Dean sent me pictures demonstrating how he used a bicycle cable, some coiled key rings and carabiners to improvise a system to keep his transducer cords from draping onto the oor, getting run over and traumatized (Fig.13.32). I used the coiled key