Portable Ultrasound

[HalO'Thane]

Does anyone have experience with the newer portable "pocket size" ultrasounds that have now come out? The two models that I know of are the Sonosite Nanno and the GE VScan. I wasn't sure how they stacked up to the larger ultrasounds in terms of both image quality and ease of use. I am envisioning a scenario where I am called to a distant location of the hospital to help with IV access or if there is a code where I want to grab an ultrasound as quickly as possible to assess cardiac function. I would feel that these smaller models would be easier to transport and boot up in an urgent situation; but I wasn't sure how effective they were for the full scope of practice that we use ultrasounds for.

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[Wiscoblue]

I see only the nanomaxx on the sonosite website. It would be quite a stretch to call it 'pocket size' and at 3 pounds it's quite heavy too.

 

[pgg]

No experience wth the mini u/s devices out there now, but they don't seem very mini.

Wake me when I can plug a 6 oz probe into a bright hi-res screen I always have in my pocket, i.e. my phone.

 

[HalO'Thane]

No experience wth the mini u/s devices out there now, but they don't seem very mini.

Wake me when I can plug a 6 oz probe into a bright hi-res screen I always have in my pocket, i.e. my phone.

Is this what you mean? https://www.lumify.philips.com/web/

The GE VScan is about the size of an iphone; probably not 6 ounces though.

 

[Cytarabine]

http://m.eurheartj.oxfordjournals.org/content/34/suppl_1/P3850

I know one of our cardiologists carries one around and uses it routinely. The vscan isn't tiny, but it's definitely pocketable. Haven't heard of one being used to place a line

Edit: and the ones I know who use it don't bill it

 

[GaseousClay]

i personally like the vscan and found it fun to walk around with and try to do a quick exam on people in residency. that being said in the private practice world it would definitely NOT be worth the cost. These things are by no means cheap.

 

[norwood]

Vscan was $10k when I looked at it 2 years ago, and was apparently suited neither to line placement nor to nerve blocks - this is all secondhand, please correct me if that's wrong. But if it can't do those things, IMHO it's not all that useful for anesthesia.

 

[HalO'Thane]

Vscan was $10k when I looked at it 2 years ago, and was apparently suited neither to line placement nor to nerve blocks - this is all secondhand, please correct me if that's wrong. But if it can't do those things, IMHO it's not all that useful for anesthesia.

Maybe they have updated their model since then. The one I saw a recently at a conference had a dual sided transducer. One side was the low-frequency phased array probe used more for viewing deeper organs, such as the heart. The other side, however, was a high-frequency linear probe that is more suited for vascular access and nerve blocks. I only viewed structures on a model and therefore have not used it on a patient yet, so other people who have should definitely chime in.

 

[pgg]

Is this what you mean? https://www.lumify.philips.com/web/

The GE VScan is about the size of an iphone; probably not 6 ounces though.

That is interesting. I'm awake now.

 

[woo]

I've used the GE VScan quite a bit.

I think it would be great for lines, however the resolution would not work at all for nerve blocks.

 

[leviathan]

Images are actually pretty decent, but the small screen makes it hard to see.

 

[CUBR]

Our cardiology fellow carries one around. Good for looking at global function and volume status, but not good enough for blocks or access.

 

[fakin' the funk]

Does anyone have experience with the newer portable "pocket size" ultrasounds that have now come out? The two models that I know of are the Sonosite Nanno and the GE VScan.

I used the VScan quite a bit during ICU fellowship. Like, every day. It is pretty close to a "stethoscope replacement" and in many ways it is better (e.g., visualizing asystole after pushing 12 of adenosine). It is quite portable. It is very basic (I don't recall it having color Doppler, M-mode, or any other fancy modalities) and a bit grainy. The battery life is maybe 30-45 minutes on a full charge. It is a great tool when called to the bedside on the medical or surgical ward for hypotension or respiratory distress, to do bedside cardiac and pulmonary ultrasound: volume status, gross systolic function, pneumothorax, pleural effusions, etc. It is a low-frequency probe so the useful depths are about 5-15cm. It's not useful for lines. I don't know the exact price but it is many thousands of dollars (?$10000+).

So, it has minimal application in everyday anesthesiology care. And, in the actual ICU, where you have better/more powerful ultrasounds sitting around, the VScan was not used much either.

 

[HalO'Thane]

I used the VScan quite a bit during ICU fellowship. Like, every day. It is pretty close to a "stethoscope replacement" and in many ways it is better (e.g., visualizing asystole after pushing 12 of adenosine). It is quite portable. It is very basic (I don't recall it having color Doppler, M-mode, or any other fancy modalities) and a bit grainy. The battery life is maybe 30-45 minutes on a full charge. It is a great tool when called to the bedside on the medical or surgical ward for hypotension or respiratory distress, to do bedside cardiac and pulmonary ultrasound: volume status, gross systolic function, pneumothorax, pleural effusions, etc. It is a low-frequency probe so the useful depths are about 5-15cm. It's not useful for lines. I don't know the exact price but it is many thousands of dollars (?$10000+).

So, it has minimal application in everyday anesthesiology care. And, in the actual ICU, where you have better/more powerful ultrasounds sitting around, the VScan was not used much either.

I guess for me that is ultimately what it comes down to. All of our department's ultrasound probes are high-frequency linear, which have very little utility for assessing the heart. The question then is would a portable ultrasound with a phased array probe help me in a crisis. I am not a cardiologist and I am not interested in guiding a cardiac surgeon in their operative management. I am merely interested in ruling out pathologies that are likely to get us into trouble: LV systolic dysfunction, RV systolic function, hypovolemia, and tamponade. Based on that, it seems like something portable such as the VScan can do it with efficiency and ease-of-use. My patient will likely not crump on me in the few minutes that it would take for me to grab one of our better ultrasounds to place a central line or a nerve block. However, if I truly need to assess cardiac function in a crisis, God knows how long it would take to get a cardiologist or sonographer to drop a TEE probe or perform a transthoracic echo, particularly if it is on the weekend or the middle of the night.

 

[deleted697127]

Anyone have experience with the imacor miniature critical care hTEE probes that are the size of an ng tube that you can leave in for 72 hours at a time?

http://imacorinc.com/htee/products/claritee.html

 

[deleted162650]

I guess for me that is ultimately what it comes down to. All of our department's ultrasound probes are high-frequency linear, which have very little utility for assessing the heart. The question then is would a portable ultrasound with a phased array probe help me in a crisis. I am not a cardiologist and I am not interested in guiding a cardiac surgeon in their operative management. I am merely interested in ruling out pathologies that are likely to get us into trouble: LV systolic dysfunction, RV systolic function, hypovolemia, and tamponade. Based on that, it seems like something portable such as the VScan can do it with efficiency and ease-of-use. My patient will likely not crump on me in the few minutes that it would take for me to grab one of our better ultrasounds to place a central line or a nerve block. However, if I truly need to assess cardiac function in a crisis, God knows how long it would take to get a cardiologist or sonographer to drop a TEE probe or perform a transthoracic echo, particularly if it is on the weekend or the middle of the night.

Why don't you just drop a TEE probe? There should be one in just about every Department that does cardiac cases these days and any BC 'oligist should be able to identify the things you listed when a pt is crumping.

 

[Ezekiel2517]

I've been in a lot of "code/crisis" situations you are referring to and never has my first move been to grab an ultrasound to see what's up with the heart. If a pt codes, it means they are dead. I'd focus on resuscitation and stabilization first. In these situations, the point of the U/S is to basically let you know if it's a volume issue or if the heart is in failure. But you should hopefully have enough clinical knowledge and judgement to make this assessment with good confidence without an U/S. Someone else can do an echo exam while you are stabilizing the pt, but if you're alone, you should save the U/S exam for later. I'm assuming you are referring to situations out of the OR where the pt is not intubated and anesthetized.

 

[fakin' the funk]

Anyone have experience with the imacor miniature critical care hTEE probes that are the size of an ng tube that you can leave in for 72 hours at a time?

http://imacorinc.com/htee/products/claritee.html

Only used this a couple times. It has some utility for very basic assessments but is nowhere near the quality of a proper TEE. The views you can get are limited because of the limited degrees of freedom of the probe, and the screen is grainy.

 

[fakin' the funk]

I've been in a lot of "code/crisis" situations you are referring to and never has my first move been to grab an ultrasound to see what's up with the heart. If a pt codes, it means they are dead. I'd focus on resuscitation and stabilization first.

I would argue that you need to ascertain what pathology you are treating before you can effectively do so. A 30 second ultrasound exam may help you do that

 

[OB1🤙]

VScan is the first thing I grab heading to a code.

I remember a recent one- active outpt for PD catheter. Crumps after induction- PEA arrest. Code called. I pop in with a VScan, 10 seconds later I see a massive pericardial effusion, 30 seconds later I have my cardiology buddy on cell phone, 5 minutes later he has a needle under the xyphoid draining out a ton of fluid, pt recovers, mic dropped, VScan FTW.

No chance that appropriate therapy would have been given in such an expedient way otherwise.

 

[leviathan]

I've been in a lot of "code/crisis" situations you are referring to and never has my first move been to grab an ultrasound to see what's up with the heart. If a pt codes, it means they are dead. I'd focus on resuscitation and stabilization first. In these situations, the point of the U/S is to basically let you know if it's a volume issue or if the heart is in failure. But you should hopefully have enough clinical knowledge and judgement to make this assessment with good confidence without an U/S. Someone else can do an echo exam while you are stabilizing the pt, but if you're alone, you should save the U/S exam for later. I'm assuming you are referring to situations out of the OR where the pt is not intubated and anesthetized.

Obviously get CPR and ACLS going, but your next move should be to figure out the cause in a PEA arrest. You'd think clinical knowledge and judgment would be enough but we are wrong all the time, and if anything an ultrasound is useful to confirm your judgment and rule out any surprises.