Single-operator Sterile Sheathing of Ultrasound Probes for Ultrasound-guided Procedures

In the emergency department (ED), one of the most common ultrasound-guided procedures is central venous cannulation (CVC). CVC is an integral component to the resuscitation of critically ill patients, allowing hemodynamic monitoring, frequent blood draws, delivery of vasopressors, and access for transvenous pacing. However, CVC insertion attempts can result in serious adverse sequelae, including mechanical complications and catheter-associated infections.¹

Ultrasound guidance has been shown to reduce time to successful CVC, number of attempts, and mechanical complications and to increase success rates.^1,2 As such, the Agency for Healthcare Research and Quality and the National Institutes of Clinical Excellence have recommended that ultrasound be used for CVC.^3,4

CVC-associated infections are a significant cause of patient morbidity and mortality, with estimated costs of over 460 million health care dollars annually.⁵ Several steps to prevent infection have already been established. These include the use of antimicrobial-impregnated catheters, choosing internal jugular or subclavian insertion sites, and sterile technique. Sterile technique consists of chlorhexidine skin prep, sterile drapes, gowns, gloves, masks, and using sterile sheaths for ultrasound probes. The proper use of these measures has accounted for significantly decreasing catheter-associated infection rates.^2,6

A fundamental step in ultrasound guidance for CVC placement and other procedures is maintaining the sterility of the procedure. Single-operator sterile sheathing can be broken down into the following steps, as demonstrated in the video (Video Clip S1).

• 1
   Place probe upright in the system probe holder.
• 2
   Place adequate nonsterile gel on the surface of the probe.
• 3
   Engage full barrier sterile precautions for operator.
• 4
   Open sterile sheath and place on nondominant hand.
• 5
   Invert sheath onto dominant hand.
• 6
   Grasp the top of the probe.
• 7
   Unfurl sheath over probe and cord.
• 8
   Secure sheath in place and smooth out air bubbles.
• 9
   Place sterile gel on sheath to allow imaging for procedural guidance.