Hand Held U/S scanner

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Very cool technology for sure, but I'm not sure about the utility, but that's just me. And I use ultrasound for most of my alines, many tough ivs, etc...
 
Too bulky.
Small screen
I'm too old to deal with those things.
Give me the small wand and bigger screen any day.
Yes, I use US on occasion.
Never needed one for an A-line tho. That's just lame 😉
 
Noyac said:
Too bulky.
Small screen
I'm too old to deal with those things.
Give me the small wand and bigger screen any day.
Yes, I use US on occasion.
Never needed one for an A-line tho. That's just lame 😉
Click to expand...
This product is completely different from a regular ultrasound, it's specific for neuraxial imaging. With that being said, I also personally don't think it would be helpful.

As for the A-line...don't knock until you try it. Supremely helpful, especially on awake patients and sick patients with crappy BP's. It also allows you to go a few inches further proximal where the artery is bigger which helps substantially.
 
facted said:
This product is completely different from a regular ultrasound, it's specific for neuraxial imaging. With that being said, I also personally don't think it would be helpful.

As for the A-line...don't knock until you try it. Supremely helpful, especially on awake patients and sick patients with crappy BP's. It also allows you to go a few inches further proximal where the artery is bigger which helps substantially.
Click to expand...
Not knocking it, just haven't needed it 😉
 
nimbus said:
I dont need it either😉....but it's just better with it, like central lines and blocks.
Click to expand...
You know I don't necessarily agree with all of this.
It may be "better" for central lines and blocks in someone who never trained before US but I have done many US guided blocks and lines I still fail to see the benefit in my practice. It's a time consumer for me. I will use it however and some blocks like the axillary and supraclavicular I use it all the time. But for the ISB,FNB, POPLITEAL I rarely use it any more. For central lines, I depends on how fast I need the line. If I have time I will do a primary scan.
I know I have mentioned all this a hundred times on this site, so forgive my redundancy. I don't propose that others give it up. Just don't call it standard of care or something stupid like that.
 
Noyac said:
You know I don't necessarily agree with all of this.
It may be "better" for central lines and blocks in someone who never trained before US but I have done many US guided blocks and lines I still fail to see the benefit in my practice. It's a time consumer for me. I will use it however and some blocks like the axillary and supraclavicular I use it all the time. But for the ISB,FNB, POPLITEAL I rarely use it any more. For central lines, I depends on how fast I need the line. If I have time I will do a primary scan.
I know I have mentioned all this a hundred times on this site, so forgive my redundancy. I don't propose that others give it up. Just don't call it standard of care or something stupid like that.
Click to expand...


I finished in 1996 so I trained and practiced without ultrasound for much of my early career. Did countless nerve stim ISBs and FNBs and yes they were easy. Still I think ultrasound is God's gift to anesthesia. It prevents a lot of f****** around. Are you seriously saying it doesn't save you time on pop-sci blocks? My self insured practice actually requires real time ultrasound for lines after we had a mishap that could have been prevented if ultrasound was used.
 
Last edited:
nimbus said:
I finished in 1996 so I trained and practiced without ultrasound for much of my early career. Did countless nerve stim ISBs and FNBs and yes they were easy. Still I think ultrasound is God's gift to anesthesia. It prevents a lot of f****** around. Are you seriously saying it doesn't save you time on pop-sci blocks? My self insured practice actually requires real time ultrasound for lines after we had a mishap that could have been prevented if ultrasound was used.
Click to expand...
Yes a pop fossa block takes me (there's a lot of bragging around these parts so I try to be realistic) less than 30sec to get twitch and less than 1 minute to inject depending on nurse. If I don't hit the nerve immediately on insertion then I quickly reassess my landmakers. I can't remember the last time it took more than 5 minutes which by the way I haven't seen anyone trul do with US if they actually count the time from the start of scanning which is part of the procedure. If you doubt me, maybe Sevo can vouch for my block times. He has seen them. Same goes for ISB.
SCIATIC blocks are different. I do an anterior approach so US isn't useful. This block "usually" takes less than 2 minutes once I start. Just saying.

I have done a lot of these.
 
nimbus said:
My self insured practice actually requires real time ultrasound for lines after we had a mishap that could have been prevented if ultrasound was used.
Click to expand...

Oh, I am aware of some of the insurance constraints on our practices. And I have no issue with the use of US in our pts. But don't think that because you used US they bring suit to you if thee is a complication. Insurance isn't saying if you use it you can't be found at fault if something bad happens. No way. So do what you think is best. In this situation, US is best.
 
Noyac said:
Yes a pop fossa block takes me (there's a lot of bragging around these parts so I try to be realistic) less than 30sec to get twitch and less than 1 minute to inject depending on nurse. If I don't hit the nerve immediately on insertion then I quickly reassess my landmakers. I can't remember the last time it took more than 5 minutes which by the way I haven't seen anyone trul do with US if they actually count the time from the start of scanning which is part of the procedure. If you doubt me, maybe Sevo can vouch for my block times. He has seen them. Same goes for ISB.
SCIATIC blocks are different. I do an anterior approach so US isn't useful. This block "usually" takes less than 2 minutes once I start. Just saying.

I have done a lot of these.
Click to expand...
5 minutes for a pop with u/s? From probe on skin to done with block is usually less than 90 seconds, though there can be exceptions with the horizontally challenged (maybe 3 or 4 minutes?).

I def. respect your use of nerve-stim. Sounds like you have it down with the nervestim though so go with what works for you, clearly.

But, there are lots of studies out there that ultrasound for many blocks is faster than nerve-stim, including scan time. Importantly, though, neither is "safer" than the other per the literature.
 
facted said:
5 minutes for a pop with u/s? From probe on skin to done with block is usually less than 90 seconds, though there can be exceptions with the horizontally challenged (maybe 3 or 4 minutes?).

I def. respect your use of nerve-stim. Sounds like you have it down with the nervestim though so go with what works for you, clearly.

But, there are lots of studies out there that ultrasound for many blocks is faster than nerve-stim, including scan time. Importantly, though, neither is "safer" than the other per the literature.
Click to expand...

You measure block time in seconds? If you're not using milliseconds, you're going too slow.
 
Noyac said:
Oh, I am aware of some of the insurance constraints on our practices. And I have no issue with the use of US in our pts. But don't think that because you used US they bring suit to you if thee is a complication. Insurance isn't saying if you use it you can't be found at fault if something bad happens. No way. So do what you think is best. In this situation, US is best.
Click to expand...

Even though I brought insurance into the discussion, it's not about medicolegal liability. It's about better patient care and actually preventing avoidable complications. And it's about getting the line with a single needle pass every time.
 
Noyac said:
Never needed one for an A-line tho. That's just lame 😉
Click to expand...
maybe I'm just uncoordinated, but I find u/s helps when putting art lines in 5 month olds
... but i think if you need u/s for a spinal in the model in the video you're lame
 
.
JobsFan said:
maybe I'm just uncoordinated, but I find u/s helps when putting art lines in 5 month olds
... but i think if you need u/s for a spinal in the model in the video you're lame
Click to expand...
That's what we used to say about U/S guided neck lines, too. Now more and more non-physicians are able/allowed to place them.

Such a machine could make a spinal/epidural so safe that it would not require any physician oversight anymore. That's what these machines are actually about, same as those that allow nurses to place post-pyloric Dobhoffs, or find small veins etc.
 
Noyac said:
Never needed one for an A-line tho. That's just lame 😉
Click to expand...

O no you di'nt


You just start poking in the super edematous patients? People with VADs? Hypotensive patients with cold extremities and no palpable pulse to speak of? That's not very nice. 😉
 
pgg said:
O no you di'nt


You just start poking in the super edematous patients? People with VADs? Hypotensive patients with cold extremities and no palpable pulse to speak of? That's not very nice. 😉
Click to expand...

As you are well aware there are certain subgroups, one of which is morbidly obese patients with low BP, where using the U/S just makes for good practice. I'd say I do 3/4 of my arterial lines the "old-fashioned way" and 1/4 under U/S. At this point in my career I just want to do what's best for the patient and will expedite the process. I typically can get the most difficult arterial lines with the palpation technique (after the CRNA has tried multiple times); but, I think that with the technology readily available these days why take the chance of multiple sticks and a hematoma if it can be avoided.

As for Central line placements the standard of care, IMHO, is at least a quick look at the anatomy of the IJ size and its relationship to the Carotid. There is simply no excuse for blindly poking around the neck especially when the IJ is either too small or non-existent in the first place. Of course, in urgent/emergent situations I still place the IJ blindly with great success (as I'm sure most of you do who practice that way).
 
nimbus said:
Even though I brought insurance into the discussion, it's not about medicolegal liability. It's about better patient care and actually preventing avoidable complications. And it's about getting the line with a single needle pass every time.
Click to expand...
For someone who has less than 1000 lines. That's not me. Or anyone else that's been in practice doing real cases. I could swan a pt faster than some could do an A-line when I was doing hearts. And that's not boasting or others. It's just that I did that many.
My routine was surgeon and PA present (surgeon in lounge usually and PA in OR ready to harvest saphenous) when pt entered the room. I would place A-line while tech placed monitors. Then I'd induce, tube, and tech handed me prep stick, drape, Cordis, swan then dressing. Done in less than 5 minutes easily. The only thing that might have slowed this down was super sick hearts that I induced slowly. I did this 1000's of times. No issues. Never once used US.
These days, this isn't possible.
I will say one thing, I was popular in the heart room because of this. We could do 3-4 hearts depending on the cases before 5pm and be home for dinner. Anyone that took longer was usually finishing their day later. Surgeons value a lot of things from a good anesthesiologists but efficiency is way up there.
 
JobsFan said:
maybe I'm just uncoordinated, but I find u/s helps when putting art lines in 5 month olds
... but i think if you need u/s for a spinal in the model in the video you're lame
Click to expand...
Well you never mentioned 5 month olds!!! That takes talent.
But I did them in pedi hearts and I can remember how challenging they were in the days before US. I loved and hated those cases all at the same time. I can still remember the one case we struggled for decent access on in training like it was yesterday. We must have taken an hour on that little kiddo. I got so frustrated that I stuck a needle into the bed pissed off at yet another failure. Then we noticed everything was wet around the kiddo. I had stuck the needle into the underbody warmer with circulating warm water. But in the end it all turned out well.
 
pgg said:
O no you di'nt


You just start poking in the super edematous patients? People with VADs? Hypotensive patients with cold extremities and no palpable pulse to speak of? That's not very nice. 😉
Click to expand...
VAD's excluded.
I have posted on this site before how to place an A-line in a pulseless pt, as I have done on more than a few pts. Feel for the "rope". Every artery no matter where it is has a distinct feel to it. Train yourself to recognize that feeling.

Bam. Now go practice young Skywalker.
 
I've been trained in the era of ultrasound so don't have much to add, but I've heard several war stories of large CVL placement into carotids only discovered halfway through the case in VAD and very sick cardiac patients. Seems pretty rare, but it's real enough that those "older" attendings permanently switched their practice afterwards.
 
We double and sometimes triple stick the IJ for many of our hearts. It could sometimes be a s***-show without ultrasound. But with US it's a piece of cake. And even with ultrasound 5min pa caths are routine. I routinely do radial Aline, induce, dlt, double stick rij cvp+ rij pa cath, and femoral Aline in 25min using US. It doesn't slow me down and it's saved me a lot of grief, especially in dialysis patients and fatties. Thrombosed IJ? No problem, scan the other one or the subclavian. Find a vessel that's patent. Your patient is 5'6" and 390# with no neck? No problem. Having practiced for years without it, I think US is a miracle.
 
Last edited:
The benefits of convenience and utility of size would be lost in the need to chain them to a 200# cart to prevent them from being thrown into the trash or walk out of the hospital.
 
Noyac said:
For someone who has less than 1000 lines. That's not me. Or anyone else that's been in practice doing real cases. I could swan a pt faster than some could do an A-line when I was doing hearts. And that's not boasting or others. It's just that I did that many.
My routine was surgeon and PA present (surgeon in lounge usually and PA in OR ready to harvest saphenous) when pt entered the room. I would place A-line while tech placed monitors. Then I'd induce, tube, and tech handed me prep stick, drape, Cordis, swan then dressing. Done in less than 5 minutes easily. The only thing that might have slowed this down was super sick hearts that I induced slowly. I did this 1000's of times. No issues. Never once used US.
These days, this isn't possible.
I will say one thing, I was popular in the heart room because of this. We could do 3-4 hearts depending on the cases before 5pm and be home for dinner. Anyone that took longer was usually finishing their day later. Surgeons value a lot of things from a good anesthesiologists but efficiency is way up there.
Click to expand...


The aforementioned complication was not caused by a rookie but a well respected partner who's been doing hearts for over 20 years.
 
drmwvr said:
The benefits of convenience and utility of size would be lost in the need to chain them to a 200# cart to prevent them from being thrown into the trash or walk out of the hospital.
Click to expand...


This is exactly why we transitioned from McGraths to glidescopes.
 
OMG! That is lightening fast. I struggle to get one US aline and one triple lumen completed, sewn in, and dressed in 20 min.
 
ACS has recommended ultrasound use for lines since 2011. Medicare will not reimburse for iatrogenic pneumothorax as of 2012

If you have ultrasound at you ur facility. Use it

Revised Statement on Recommendations for Use of Real-Time Ultrasound Guidance for Placement of Central Venous Catheters

"Evidence-based guidelines from many medical organizations, including the Centers for Disease Control (CDC)9, American College of Emergency Physicians10, and the National Institute of Clinical Excellence (NICE),11 recommend ultrasound-guided central line placement based on its overwhelming safety benefits."

Ultrasound helps reduce a $373 million-dollar risk: Medicare penalties for hospital errors

Don't be a cowboy. Yes. Many of us trained under the blind technique. Yes. In the hands of a very experienced person. They can do it quicker without ultrasound. But the bell curve for safety eventually dictates the use of ultrasound. We all can't be in the top 1% of procedures.

"Standards" are few and far in medicine. Most are just "guidelines". Look how long it took for the ASA to mandate the use of end tidal co2 for Mac "deep sedation". It took them till 2011 to mandate it as the "standard"

Ultrasound will be the "standard" sooner than later for medical legal reasons and safety for elective procedures.
 
drmwvr said:
The benefits of convenience and utility of size would be lost in the need to chain them to a 200# cart to prevent them from being thrown into the trash or walk out of the hospital.
Click to expand...
At the PGA this past year, some company showed me an ultrasound with a portable wireless probe. I told them it was the worst idea I've ever seen. They didn't get it...I explained and they still didn't get it. I just laughed and walked away.
 
nimbus said:
The aforementioned complication was not caused by a rookie but a well respected partner who's been doing hearts for over 20 years.
Click to expand...
It can happen to anyone. I understand this. Maybe he let his spidey sense lapse for just a moment. Who knows.
 
aneftp said:
Ultrasound will be the "standard" sooner than later for medical legal reasons and safety for elective procedures.
Click to expand...
Only because nobody will no how to do one without it.

Now nothing will slow down an OR like having more blocks/lines than US machines to get the day started and a bunch of people that can't or won't proceed without the US. Then someone struggles and now everyone is pissed. I've seen it.
 
Noyac said:
Only because nobody will no how to do one without it.

Now nothing will slow down an OR like having more blocks/lines than US machines to get the day started and a bunch of people that can't or won't proceed without the US. Then someone struggles and now everyone is pissed. I've seen it.
Click to expand...

Do you do blind nasal intubation? Cause the gurus who trained in the 1960s and 1970s wil swear up and down they can intubate faster with a difficult intubation. They will laugh at you it takes too long to prepare and get the fiberoptic scope ready.
 
aneftp said:
Do you do blind nasal intubation? Cause the gurus who trained in the 1960s and 1970s wil swear up and down they can intubate faster with a difficult intubation. They will laugh at you it takes too long to prepare and get the fiberoptic scope ready.
Click to expand...
True. I'm not that good at those though. I haven't done enough. But I've seen it done Lickity split. I've also seen it not done so smooth. It's all about chasing the condensation.
 
Noy if what you say is true and i don't doubt you (although you can't say with a strait face that all your a lines are in in less than 5min), you are talking about something that is impossible for 99% of anesthesiologists.
 
I consider myself reasonably technically proficient. I'm in the last few weeks of CT fellowship so I've had a solid year doing lots of lines in the worst vasculopaths. Prior to fellowship I practiced for a a few years so while I'm young 🙂 I'm not new.

Over the weekend I did a transplant in a guy with a VAD. Even though he had a pulse and I could feel the vessel, I started with ultrasound anyway ... and I still failed to get a radial a-line. Vessel was right there. Easy flash, couldn't thread the catheter. After a few attempts I gave up and put in a brachial a-line. I probably should've gone brachial sooner, but looking at and feeling the vessel I kept thinking "this time for sure ..."

Probably 70%+ of the time I hit a-lines without ultrasound first needle pass. Another 20% I get within a couple minutes. There are some that are humbling though. I reach for the ultrasound early.
 
dhb said:
Noy if what you say is true and i don't doubt you (although you can't say with a strait face that all your a lines are in in less than 5min), you are talking about something that is impossible for 99% of anesthesiologists.
Click to expand...
Not all lines. I always prep the RIJ and RSC area together just in case. It's my superstition. But I much preferred the LSC for swans if the RIJ didn't work.
Also, I don't want to give the impression that I don't use the US. I do use it in controlled settings with no time constraints. I typically scan then put it down then scan again once the wire is in to confirm and take a picture. Is this how everyone does it or do you use it live?
I had a bad trauma Friday night that was was exsanguinating in her abdomen. She came up straight from the ER and I was on my way in from home. I got in as they rolled into the OR. We couldn't get her stabilized, thoracotomy (this was the first time I ever did open cardiac massage btw) showed no pulmonary rupture. Laparotomy next and abdominal cavity was filling up with blood. ER placed two cordis' in the groin. No good since everything I put in her came out in the surgical field. I threw in a RSC cordis lickity split (it was only difficult for a second since she had no intravascular volume at all, vitals were nil). The point of this is that there are times that you need to be confident in your skills in unusual situations where all the tools are either not available to you or they will only slow things down when that's the last thing you need.
 
Noyac said:
ER placed two cordis' in the groin. No good since everything I put in her came out in the surgical field. I threw in a RSC cordis lickity split (it was only difficult for a second since she had no intravascular volume at all, vitals were nil).
Click to expand...

So you scrubbed in while the surgeon was operating on the abdomen?
 
Arch Guillotti said:
So you scrubbed in while the surgeon was operating on the abdomen?
Click to expand...
Nope! Surgeons never scrubbed in either. We never even put masks on. We all just went to work as fast as possible. No time for AORN bullsh*t.
This was a terrible case. Full court press as soon as she hit the ER doors.
 
I also started before generalized use of US so i'm right there with you, but just today a collegue had a bad vasculopath, ESRD multiple amputation patient crumple after induction, i tried to get an a-line with US and couldn't get it on either side.
Sometimes it's just impossible, the young trauma is a different league.
 
dhb said:
I also started before generalized use of US so i'm right there with you, but just today a collegue had a bad vasculopath, ESRD multiple amputation patient crumple after induction, i tried to get an a-line with US and couldn't get it on either side.
Sometimes it's just impossible, the young trauma is a different league.
Click to expand...

If you can't get it via the "axillary approach" then 99% of the time nobody can get it.

Axillary Art Lines in Adults?
 
I like to go "high" in the axilla preferably just as the axilla meets the chest wall area:

1ae92658c4725fa70f988a54d543e6ea.jpg
 
Noyac said:
Only because nobody will no how to do one without it.

Now nothing will slow down an OR like having more blocks/lines than US machines to get the day started and a bunch of people that can't or won't proceed without the US. Then someone struggles and now everyone is pissed. I've seen it.
Click to expand...
1 central line in the carotid in the wrong patient might change your mind.

I don't see what we do as slowing anything down. Surgeons take 45 mins and 5 nurses to I&d an abscess. We can take as much time as we need
 
Newtwo said:
I don't see what we do as slowing anything down. Surgeons take 45 mins and 5 nurses to I&d an abscess. We can take as much time as we need
Click to expand...
True, until your partners are better at time management than you and then you are not necessarily looked at as an efficient anesthesiologist. I'm not saying it's right. Just that it is reality.

I'm also not saying that US delays are all that burdensome. Just that it is an additional "safety" step added to an already mostly safe procedure. Extremely safe in regional where I find the US is more limited in its usefulness for me.
 
You must log in or register to reply here.

Similar threads

C
S corp reasonable salary
2
Replies
58
Views
7K
caligas
C
N
Dosing spinals for C/S after Epidural
2
Replies
76
Views
6K
deleted1183938
D
Agast
NC Supreme Court rules CRNA can be held responsible for case outcome
2
Replies
62
Views
5K
wholeheartedly
wholeheartedly
coffeebythelake
Mindray handheld ultrasounds
Replies
5
Views
1K
AppTrail
AppTrail
L
Hand model
Replies
21
Views
3K
PainDrain
P
Top