Emergency physician utilization of transvaginal ultrasound after initiation of revised sterilization protocol

O’Connor, Timothy P.; Garton, Nathan; Jones, Courtney Marie Cora; Estephan, Michael; Lu, Michael T.; Adler, David

doi:10.1016/j.ajem.2018.08.077

Cited by 4 publications

(5 citation statements)

References 1 publication

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“…It is often suggested that once an IUP is identified on TAUS, the pursuit of subsequent TVUS is not necessary. 15,16 This is based on the logic that an ectopic pregnancy is almost entirely excluded once an IUP is identified. Therefore, the primary "question" or purpose of the ultrasound is complete once an IUP is visualized on TAUS.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Transvaginal Ultrasound After Intrauterine Pregnancy Identification on Transabdominal Ultrasound in Emergency Department Patients

Thom¹,

Kongkatong²,

Moak³

2023

OAEM

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Introduction: Ultrasonography has an important role in the evaluation of Emergency Department (ED) patients presenting with early pregnancy complaints. Both transabdominal (TAUS) and transvaginal ultrasound (TVUS) can be utilized. While TVUS generally allows for greater detail, it is unclear how much added benefit exists in performing TVUS once an intrauterine pregnancy (IUP) has been identified on TAUS. Methods: This was a retrospective study utilizing Radiology Department ultrasound examinations obtained in first trimester pregnancy ED patients during a consecutive four month period in 2019. Studies wherein both TAUS and TVUS were both performed were included. Two ED physicians with specialized training in point of care ultrasound reviewed only the TAUS images from these studies. Their findings were compared to the Radiologist interpretation, which was inclusive of both TAUS and TVUS components of the study. Results: 108 studies met inclusion criteria. Amongst these, 82 had IUP's identified on the radiologist report. 69 studies had an IUP identified by ED physician review of the TAUS images, with 1 false positive. Each case of intrauterine fetal demise (IUFD) was identified on ED physician review of TAUS. Two ectopic pregnancies were present, neither of which was mistaken for IUP on ED physician TAUS review. There were 15 studies with subchorionic hemorrhage and 3 studies with an ovarian cyst noted on the radiologist report. Conclusion: Following the identification of an IUP on TAUS, the added diagnostic value of TVUS amongst this cohort of ED patients was low. Given the added time and cost of TVUS, selective instead of routine usage should be encouraged.

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Section: Discussionmentioning

confidence: 99%

The Utility of Transvaginal Ultrasound After Intrauterine Pregnancy Identification on Transabdominal Ultrasound in Emergency Department Patients

Thom¹,

Kongkatong²,

Moak³

2023

OAEM

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“…Clinicians in emergency departments and those in obstetrics and gynecology internationally have reported difficulties in adhering to current disinfection protocols, which take several minutes, delaying patient care and interrupting workflow 25 , 27 . Although it has been estimated that the multiwipe system takes 2–3 min 20 , in clinical practice we have found this to be longer, especially when compared with the use of the UV‐C device.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of training or time to use correctly the abovementioned methods may result in inadequate HLD 1 , 4 , 23 , 24 , 25 . Automated hydrogen peroxide devices used within a ‘sonically activated’ closed system (instead of manual reprocessing) reduce chemical exposure and have high antimicrobial effectiveness but take 7 min per cycle 3 , 12 , 26 , 27 , 28 . Automated ultraviolet‐C radiation (UV‐C) devices offer safe and reusable chemical‐free HLD, are highly effective at eradicating pathogens, including HPV, and take 90 s per cycle 1 , 4 , 24 , 29 , 30 , 31 , 32 , 33 .…”

Section: Introductionmentioning

confidence: 99%

Time‐effectiveness and convenience of transvaginal ultrasound probe disinfection using ultraviolet vs chlorine dioxide multistep wipe system: prospective survey study

Kyriacou

Robinson

Barcroft

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?Compared with the chlorine dioxide multistep wipe system, ultraviolet technology is a more time-efficient method of transvaginal ultrasound probe disinfection and allows more essential tasks to be completed during probe disinfection. For a 4-h ultrasound list of 15 patients, 55 min 45 s extra time can be saved using the ultraviolet disinfection approach. Healthcare professionals preferred the ultraviolet technology and found it easier to use than the chlorine dioxide multistep wipe system. What are the clinical implications of this work?The additional time saved when utilizing ultraviolet technology may allow approximately three additional patients to be seen per ultrasound list, amounting to six extra patients per day. This would potentially increase patient throughput, reduce waiting times and, in some healthcare settings, increase the income a unit can generate.

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“…2) Few training opportunities: emergency medicine residents find limited training opportunities when working with attendings who do not perform TVUS and when patients are preferentially transported to the radiology for TVUS. 3) Infection control measures: POCUS leaders anecdotally note the increasing surveillance in transducer cleaning and sterilization practices as a deterrent to performing a TVUS examination 6 .…”

Section: Lettermentioning

confidence: 99%

“…A pelvic POCUS examination seeks to answer the focused question, "Is there an intrauterine pregnancy (IUP)" and risk stratifies the patient when ectopic pregnancy is a clinical concern [1]. POCUS leaders anecdotally note the increasing surveillance in transducer cleaning and sterilization practices as a deterrent to performing a TVUS examination [6].…”

Section: Lettermentioning

confidence: 99%

Rekindling the Relevance of Obstetrical Transvaginal Point of Care Ultrasound: Overcoming Barriers to Ensure Patient-Centered Care

Salerno,

Lewiss

2023

pocus

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Emergency physician utilization of transvaginal ultrasound after initiation of revised sterilization protocol

Cited by 4 publications

References 1 publication

The Utility of Transvaginal Ultrasound After Intrauterine Pregnancy Identification on Transabdominal Ultrasound in Emergency Department Patients

The Utility of Transvaginal Ultrasound After Intrauterine Pregnancy Identification on Transabdominal Ultrasound in Emergency Department Patients

Time‐effectiveness and convenience of transvaginal ultrasound probe disinfection using ultraviolet vs chlorine dioxide multistep wipe system: prospective survey study

Rekindling the Relevance of Obstetrical Transvaginal Point of Care Ultrasound: Overcoming Barriers to Ensure Patient-Centered Care

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