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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5784_Библиотеки_им_академика_М_И_Перельмана.pdf
13 Ultrasound Equipment Maintenance
Fig. 13.32 Early
transducer cord bungee
system: 2004, thanks to Dr.
Anthony Dean
201
rings he suggested but modied the system by adding ¾in.×8in. Velcro cable ties
to the key ring bungees, so there would be a rm but still adjustable point of attachment to the transducer cord. Total cost for the system was about $2.50 per cord
(Fig.13.33).
So what is the process? Attach the Velcro cable tie snug around the transducer
cord, and then wrap it through the key ring several times, adjusting the Velcro
attachment to a location along the mid length of the cord such that the cord can
never hit the oor. Depending on the machine and number of transducer cords and
attachment sites, you can either bundle several transducer cords together or wrap
them individually (Fig.13.34). Some machines may end up with four individual
202
Fig. 13.33 Transducer
cord bungee parts, next
version: coiled key rings
and ¾″×8″ Velcro cable
ties
A. Dewitz
Fig. 13.34 Transducer cords can be bundled together or attached individually, depending on the
machine.
13 Ultrasound Equipment Maintenance
Fig. 13.35 A fourtransducer ultrasound
machine with cord bungees
in place; note that the cords
never touch the oor
203
transducer cord bungees (Fig.13.35) Points of attachment are going to be dictated
by what you have available to work with on the underside of the machine in question. You can use plastic cable ties to provide an attachment site to the underside of
the frame if no other suitable locations can be found.
The return on your investment is fantastic! $30in supplies can provide protection
for about $30,000 worth of transducers. The only down side with the coiled key ring
bungee system is that over time, the coiled plastic will stretch out and lose some of
it springiness, so they will need periodic replacement.
After digging around in my local hardware store’s spring section, my more recent
iteration of this bungee system replaces the coiled key rings with a 4.5in. stainless
steel extension spring (rated maximum load 1.61 lbs., part number 304, Jones
Spring Company, about $1.50 apiece). After 3 years of use on multiple ED ultrasound machines these piano wire extension springs have worked very well and are
much more robust than the coiled plastic key ring bungees used previously
(Fig.13.36a).
204
A. Dewitz
a
b
c
Fig. 13.36 (a) Newer transducer cord bungee system using coiled key rings, extension springs,
metal key rings and Velcro cable ties. Close-ups of setup technique. (b) Technique for fashioning
a custom power cord bungee. (c) Intalled custom power cord bungee
13 Ultrasound Equipment Maintenance
205
A similar cord bungee solution can also be used to keep your power cords from
getting run over. One option is to use a metal extension spring that has a higher maximum load rating (Jones Spring company, part number 306, rated maximum load
2.61lbs.) as a bungee device suitable for use on the ultrasound machine’s heavier
power cord. Most recently I have found that a short piece of actual bungee cord can be
easily customized and very successfully employed for this purpose (Figs.13.36b, c).
One nal transducer cord bungee option uses a retractable key ring system with
an extraordinarily robust polycarbonate and Kevlar retractable key fob (KEY-BAK
#488B—about $13 apiece) that serves as a stellar cord bungee device (thank you Dr.
Mike Stone for nding this!). If you chose this option and have lots of machines to
outt, your initial outlay for supplies may be several hundred dollars, but this is still
cheap when compared to the price of the equipment being protected. The key fobs
can be attached with a Velcro cable tie similar to the extension spring based system,
one retractable fob for each cord (Fig.13.37).
Once the Velcro cable ties are attached to the transducer cord and adjusted to the
optimal location that keeps the cord off the oor, you can mark the cord’s “sweet
spot” with a gentian violet skin marker to make this location readily visually apparent. (Tape off the edges of this designated “sweet spot” about 1.5in. apart, and make
sure you wear gloves when applying the marker ink! Remove the tape when dry.) If
added transducer cord length is needed for a procedure such as a central line placement, you can simply slide the transducer cord through its snug (but not immobile)
Velcro cable tie attachment in order to lengthen the amount of transducer cord
available. When the procedure is done, you simply slide the cord bungee back to its
visually prominent “sweet spot” ensuring once again, that your transducer cords
will not hit the oor and get run over (Fig.13.38).
Fig. 13.37 Key fob bungee set up, same idea, key fobs used instead of extension springs
206
Fig. 13.38 Mark the sweet spot along the cord where the Velcro cable tie keeps the transducer
cord off the oor. Tape off the area rst, wear gloves, and remove tape when dry. The transducer
cord can slide out from its usual attachment site if a longer length is needed for a procedure. Return
the cable tie and cord bungee back to the easily visible “sweet spot” when done
Fig. 13.39 Spiral
loom—another transducer
cord protection strategy
A. Dewitz
Another suggested transducer cord protection approach forwarded to me by Dr.
Hal Minnigan is to armor coat the proximal transducer cord with a thick spiral plastic material (spiral loom) (Fig.13.39). The transducer cord near the oor is thereby
protected with a much more rigid exterior coating.
After many years of requests for more robust transducer cords, one vendor now
offers armored cable technology with an armored cable jacket surrounding the electrical conductors of their transducer cords.
There are many other ultrasound equipment modications that can make our
machines more user friendly and fun and I will briey run through some of these
additional modications below.
Power Cords
Power cords can present any one of a number of challenges. An overly stiff power
cord can be difcult to coil up when the machine is stored, plug end pins will inevitably get broken or bent, power cord storage sites on the cart are often placed in
ergonomically challenging locations, and these attachment sites may break from
overuse/excessive force. I have yet to see an ultrasound machine with a
13 Ultrasound Equipment Maintenance
Fig. 13.40 A low power
cord attachment site: a
poor design feature for any
mobile US machine that
needs to be backed into a
patient care area, and a
guarantee that the power
cord will be run over
207
well- designed power cord storage solution. A low power cord attachment site on the
back of the ultrasound cart is a poor design feature for a machine that is typically
rolled into a corner of a patient examining room (Fig.13.40). Inevitably, the power
cord will get run over and impede cart movement in the process. A simple workaround involves creating a higher power cord tether point so that the cord will not
contact the caster wheels when the machine is pushed into the corner of a room.
Tethering options include using coiled key rings (they will stretch out with time,
however), using the heavier gauge wire extension springs mentioned above (part
#306) to create a power cord bungee (attach with metal key rings and Velcro cable
ties), or using a small piece of actual bungee cord customized for the job.
Alternatively you can just tether the power cord with Velcro sticky-back tape to a
higher location on the back of the cart handle or frame if such a space is available;
make sure you do this at maximal cart height so you don’t limit the cart’s potential
for vertical adjustment (Fig.13.41).
What about other power cord solutions? Retractable cord systems are already
found on many portable X-ray machines. My 10
+
-year-old vacuum cleaner has a
trouble-free retractable power cord system, so why haven’t we yet seen something
like this on an ultrasound machine to help provide us with a convenient cord management solution? Or at the very minimum, a robust, well-designed, and
208
Fig. 13.41 Three power cord tethering solutions: use a coiled key ring bungee, or a more robust
extension spring, or tether the power cord to the back handle of the cart if this option is available.
See Fig.13.36c for the custom power cord bungee option
A. Dewitz
Fig. 13.42 A docking station system for recharging the ultrasound machine. No power cord issues
here
ergonomically located cord storage area integral to the cart, not a cheaply made,
plastic, and poorly located afterthought destined for an early demise. After many
years of requests, one vendor now offers a retractable power cord system on their
US cart; hopefully, more will follow. Another appealing option would be to avoid
having a power cord altogether. One ultrasound equipment vendor offers a no-cord
option with a power docking station on the cart base. The machine slides onto a
xed charging port when it is placed in its storage area to recharge its battery
(Fig.13.42).
In our search for electrons to feed our point-of-care buddy, it is not uncommon
to nd that the only available outlet in the patient care booth is located in a poorly
accessible and ergonomically challenging location. With advancements in battery
13 Ultrasound Equipment Maintenance
Fig. 13.43 Supply holders for your US gel and disinfectant sprays made from common hardware
store plumbing supplies and plastic cable ties. Plastic cable ties were used to attach them to the cart
body or the cart handle. Here they do double duty as power cord holders
209
technology and induction-based battery charging systems we can hope for a time in
the not too distant future when we can move away from the tether of a power cord
on our ultrasound equipment altogether.
Gel andCleaning Spay Holders
Some of our older machines were designed without much thought as to where ultrasound gel and cleaning spray were to be stored. Common hardware store supplies
such as PVC pipe ends and rubber plumbing parts can be easily fashioned into US
gel and cleaning spray holders. These storage cups can then do double duty and
serve as a convenient place to store your power cord as well (Fig.13.43).
Small Parts Transducer Holder
Shortly after purchase of a brand new $10,000 small parts transducer, I attached it
and placed it in the cup holder of a $100,000
+
US machine for storage, whereupon
it slipped right through the opening and onto the oor! There was no mention from
the vendor that the built-in cup holders would not work for this transducer, and no
vendor work-around or remedy was offered or suggested. So, another invitation to
customize. Our hospital plumbers happened to be working in the ED that week
installing some thick but exible adhesive plastic bathroom baseboard. A small
piece of this product was easily trimmed to size with scissors and a scalpel, with just
the right size opening for the transducer cord but too small for the hockey stick
transducer to fall through. Make sure to place it sticky side down to glue it rmly
into the base of the cup holder. Another problem successfully MacGuyvered and
working ne for many years now (Fig.13.44).
210
Fig. 13.44 A transducer
cup holder modication for
a hockey stick transducer:
a piece of sticky-back
plastic baseboard has been
cut to size to keep the
probe from falling through
US Carts Are Not Sacrosanct!
A. Dewitz
If needed, you can customize your ultrasound cart with some conveniently located
screws to attach something else to. Call the company and nd out if anything important is located on the portion of the cart body that you want to drill into. Pick a
structurally solid area for your point of attachment, drill and attach your cable ties
or screws as needed.
Color Code Your Transducers
Like most US cart modications, this one began as a poor design work-around. One
vendor’s product required that you visually follow the transducer cord back to the
underside of the machine to determine which of the three available transducer
switches you needed to activate to use that transducer. Color-coding the individual
transducers, their respective switches and their designated cup holders made activation of the correct transducer for clinical use much easier (Fig.13.45).
US Cart Supplies
Among the many point-of-care applications you will be using your ultrasound
equipment for, you will very likely be using your machines to insert substantial
numbers of US-guided peripheral lines in your difcult access patients. If this is the