Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5784_Библиотеки_им_академика_М_И_Перельмана.pdf
13 Ultrasound Equipment Maintenance
Fig. 13.45 Colored electrical tape used to make transducer activation easier and to ensure each
transducer is returned to its designated up cup holder
Fig. 13.46 Save the hard packing foam that arrives with a new machine. You can easily cut it into
custom dividers for your storage areas. Use Velcro sticky-back tape to hold the dividers in place
211
case, it is most helpful to have your US carts fully stocked with all the requisite
procedural supplies, roll-up and ready to go.
For efcient US PIV program operation you will want to stock your cart with
tourniquets, Chloraprep skin wipes, sterile adhesive dressings (one to cover your
probe and another to apply over the foam dressing at the end of the procedure),
sterile surgical lubricant, a box of non-sterile gloves, a foam vein-securing device,
appropriate length peripheral IV needles (48mm and 64mm), and benzoin swabs.
The hard packing foam that comes with a new machine and some Velcro stickyback tape can be easily fashioned into a storage space divider to help keep your
supplies neat and organized (Fig.13.46). Get creative with what you have available.
Your empty sterile adhesive dressing boxes can be trimmed and taped together with
colored duct tape and be repurposed into sturdy supply organizers (Fig.13.47). Find
a suitable site on the cart to attach your new supply organizer and industrial Velcro
sticky-back tape will take care of the rest (Fig.13.48). Label the individual compart-
ments of your storage spaces and supply box cubbies to help keep your supplies
organized and facilitate restocking. Other machines might have a suitable location
where you can attach a small plastic supply basket that you can purchase at any
hardware store. Attach the baskets to the cart with a coiled key ring and Velcro cable
ties or Velcro sticky-back tape. Location will be dictated by what free cart surfaces
you have available to work with. Laminate and attach a restocking list on the side of
212
Fig. 13.47 Repurpose your empty sterile adhesive dressing boxes. Attach them together with
colored duct tape, place the industrial Velcro sticky-back tape on the back, and then nd a suitable
place on your cart to attach it to. Label the individual cubbies to facilitate stocking and keep things
neat
A. Dewitz
Fig. 13.48 Your new
homemade supply
organizer attached to the
cart with industrial Velcro
sticky-back tape
13 Ultrasound Equipment Maintenance
Fig. 13.49 Other supply organizer options: plastic supply baskets, attached with Velcro cable ties
and coiled key rings or industrial Velcro. Add a laminated restocking list to the supply basket to
remind others what needs to go on the cart
Fig. 13.50 Custom
wooden bracket probe
wipe holder made by a
hospital carpenter, picture
thanks to Dr. Hal Minnigan
213
the storage basket to remind (other) people what needs to be restocked (Fig.13.49).
Your hospital carpenters may be able to help you out as well. Dr. Hal Minnigan had
them build a custom bracket on his ultrasound cart to hold a container of probe
wipes (Fig.13.50).
214
Fig. 13.51 Industrial
Velcro: for attaching
aftermarket equipment and
supply baskets to your
carts
A. Dewitz
Industrial Velcro
It is amazing what Velcro can hold in place; if you have any doubts, watch the
Letterman Velcro Suit clip on You Tube sometime. You can attach all manner of
aftermarket devices to your cart with it (digital image recorders, portable wireless
access point devices, supply storage boxes, etc.) (Fig.13.51). Now that wireless
features are built into many new US systems, however, we have less need for some
of these aftermarket add-ons.
Label Maker
Without a doubt, you should buy one. This is a relatively cheap item ($30–$100
dollars) that will give you a big bang for your buck (Fig.13.52). It will quickly
become an essential part of your headache reduction plan. Use it to remind people
where the machine needs to be returned to, that the machine should be plugged in
when stored, and that the transducers need to be cleaned after each use (some users
still seem to think there is an automatic probe cleaning feature on board) (Fig.13.53).
On our older machines with far too many control surface buttons, we highlighted
the seven most commonly used buttons in numerical sequence for ease of use.
Labeling your transducer cups will help remind users to return each transducer to its
designated location, thereby avoiding cord spaghetti.
Velcro andPlastic Cable Ties
Use them to keep any exposed wiring or cables neat and organized.
13 Ultrasound Equipment Maintenance
Fig. 13.52 A label maker:
an essential part of your
armamentarium. Buy one
215
Fig. 13.53 Labels gone wild! They will help keep your eet clean, safely stored, charged up, and
help minimize avoidable damage
Midline Markers
After many years of requests to add this feature, several US vendors now have a
midline mark etched onto the short axis face of their linear and curved array transducers (Fig. 13.54). This midline mark helps improve the accuracy of the many
“map and mark” or free-hand ultrasound-guided procedures we perform. If you
don’t have them etched on your transducers already, you can add this feature
216
Fig. 13.54 Newer point-of-care US machines now have a midline mark etched on the short axis
face of their linear array and curved array transducers. This improves your “map and mark” and
free-hand procedure accuracy
Fig. 13.55 For older
transducers with no
midline markers, map the
midline carefully, tape off
with electrical tape and
then mark the short axis
face on both sides of the
transducer with an
indelible marker. Remove
tape when dry
A. Dewitz
yourself. Measure carefully, mask off the short axis midline with some electrician’s
tape, and then mark the area yourself with an indelible marker. You will need to
“repaint” the area periodically, however, since your marker ink will eventually wear
off (Fig.13.55).
13 Ultrasound Equipment Maintenance
Fig. 13.56 Class up your artistically challenged work environment. Add some art to your
machines with a clear self-adhesive laminating sheet or have a custom adhesive skin made as for
a laptop
217
Artwork
Most EDs are artistically challenged places, so customize your ultrasound machines
with some artwork that you and others can enjoy in your daily work life. Find some
generally acceptable artwork you like and attach it with a clear self-adhesive laminating sheet (Fig.13.56) or have a custom adhesive skin made for your machine’s
cart as is commonly done for laptops. Hospital CT scanners and portable X-ray
machines are now often seen with artwork decals afxed to their surfaces, so why
not the same for our ED ultrasound equipment?
Anthropomorphize Your Fleet
Whether you have only one machine or an entire eet to care for, naming your
machine(s) can have a number of positive downstream benets. Surprisingly,
people seem to take better care of your ultrasound machines when you anthropomorphize them. Our ED eet’s oldest machines are now affectionately known
as Grandma and Grandpa; we also have Miro (with nice artwork on his laptop
cover), Thing One and Thing Two (thank you, Dr. Seuss), T-Bird in our Trauma
hallway, Graucho, Chico, and Harpo in our Simulation Center, and Zeppo in our
Pedi ED.Our latest arrivals were bestowed with the names Yoda and Obi-Wan
(May the Force be with you!). As an added benet, when you have many
machines and something goes wrong in your ultrasound family, it helps to know
which one of your kids is in trouble so you can easily arrange for appropriate
remediation.
218
Fig. 13.57 Plant your ag. Mark your equipment storage area with appropriate signage to keep
out interlopers. Have your hospital electricians place the outlets up high to save your back
A. Dewitz
Signage
Nature abhors a void, especially in a busy ED.Once you have staked out your ultrasound storage areas you should claim your turf and plant your ag with appropriate
signage. Have your hospital’s sign supplier make up a number of “Ultrasound
Storage Area Only” signs for you to hang on the wall where your machines will be
parked (Fig.13.57). Otherwise, that storage space will quickly ll up with all manner of interlopers such as IV poles, wheelchairs, EKG machines, thermometer/BP/
pulse oximetry carts, WOWs, and what have you as soon as you take your machines
out to use them. As noted previously, have your hospital electricians place the outlets up high so you can easily plug the machines in and out 15–20 times a shift
without wrecking your back. If you have new construction ongoing in your physical
plant, make sure you are involved in the design process early on. Ensure that you
will have designated storage areas constructed to protect and charge up your US
machines. Proactive involvement and careful measurement of how much space will
be needed to freely roll a machine in and out of a storage area cannot be overemphasized. Finding another equipment storage solution once a storage space has been
lost due to poor planning can be very time consuming and most vexing.
Ultrasound Supply Storage Cabinets
If you have a large physical plant, locate several US supply cabinets on either ends
of your ED/ICU/clinic for easy access to your frequently needed supplies and for
easy cart restocking. Have your ED/ICU/clinic manager and medical workers help
keep these storage areas stocked. With such a system in place you will be able to
quickly and efciently restock your US cart with a brief pit stop, even in the midst
of a busy clinical shift (Fig.13.58).
13 Ultrasound Equipment Maintenance
Fig. 13.58 Set up an US
supply storage cabinet in a
conveniently located area
in your workplace. Have
all your US cart items
available in this cabinet for
easy restocking
219
Fig. 13.59 Use a poster
printer to create US
educational posters for
your clinical work areas
and US Section posters to
advertise your section’s
ongoing activities
Poster Printer
If you work in an academic setting and your department either owns or has access
to a poster printer (Fig.13.59), you can use this item to advantage to create US
educational posters or to advertise your US Section’s ongoing activities on a
220
Fig. 13.60 A
representative Ultrasound
Section poster with
mission statement,
publications, ongoing
research activities,
interesting cases, etc.
A. Dewitz
bulletin board (Fig.13.60). Create your poster as a slide in PowerPoint using the
“Page Setup” and “Custom” settings to select your poster width, height, and orientation. Once completed, the le can be easily exported to your poster printer for
printing.
Service Options
What are the common service options available to you to x the things that you cannot x yourself? You’ve got ve options to choose from and the relative merits of
each are discussed briey below.
Original Equipment Manufacturer
The Original Equipment Manufacturer will be more than happy to sell you a service
contract. Maintenance contracts vary with the upfront equipment cost and the number of transducers covered. Read the ne print. A typical contract will run about
$7000–$10,000 a year for a 3-probe machine and usually covers replacement of a
damaged transducer, equipment troubleshooting, any required repairs when something breaks down, software upgrades, and 1–2 preventive maintenance visits/year.
If the budget allows and money is no object, get it.