Single-operator Sterile Sheathing of Ultrasound Probes for Ultrasound-guided Procedures
Article first published online: 2 NOV 2010
© 2010 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 17, Issue 11, page e153, November 2010
How to Cite
Trotter, M., Nomura, J. T. and Sierzenski, P. R. (2010), Single-operator Sterile Sheathing of Ultrasound Probes for Ultrasound-guided Procedures. Academic Emergency Medicine, 17: e153. doi: 10.1111/j.1553-2712.2010.00921.x
- Issue published online: 2 NOV 2010
- Article first published online: 2 NOV 2010
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).
- 1Place probe upright in the system probe holder.
- 2Place adequate nonsterile gel on the surface of the probe.
- 3Engage full barrier sterile precautions for operator.
- 4Open sterile sheath and place on nondominant hand.
- 5Invert sheath onto dominant hand.
- 6Grasp the top of the probe.
- 7Unfurl sheath over probe and cord.
- 8Secure sheath in place and smooth out air bubbles.
- 9Place sterile gel on sheath to allow imaging for procedural guidance.
- 3Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001; 43:1–688., , , , .
- 4National Institute for Clinical Excellence. Guidance on the Use of Ultrasound Locating Devices for Placement of Central Venous Catheters. National Institutes for Clinical Excellence. 2002
Video Clip S1. Single-operator sterile sheathing.
The video clip is in QuickTime.
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|ACEM_921_sm_VideoClipS1.mov||51252K||Supporting info item|
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