Value Add

The Transformational Role of Hand-Carried Ultrasound

HCU at the point-of-care provides clinical information not otherwise available from the physical exam alone and facilitates caregiver-patient interaction

Hand-carried ultrasound (HCU) is a powerful front-line medical tool and has the potential to be deployed effectively by a wide array of clinical personnel from medics to nurse practitioners to specialists.

By bringing ultrasound visualisation and guidance to the point-of-patient care, physicians are able to provide better, more comprehensive care and increase patient safety while improving their productivity and efficiency. More and more, HCU is viewed as an essential, everyday tool in clinical practice and for the practice of good medicine in general.

Significantly less expensive than their cart-based counterparts and with comparable image quality, SonoSite's hand-carried ultrasound systems can make a genuine difference to hospital working practices and patient care. HCU systems are able to deliver solutions that improve patient care, reduce costs and increase department efficiency.

Also, ultrasound visualisation as an extension of the physical examination and for procedural guidance is, or is becoming, a standard of care among many non-traditional ultrasound user groups, including emergency medicine, breast surgeons, intensivists and anesthesiologists.

High quality images are essential but a principal advantage of SonoSite's systems is their flexibility to go anywhere a patient needs medical attention —this can even mean remote, rural communities, where a durable, totally self-contained system is essential. HCU has been used in natural disasters such as the December 2004 Tsunami in Asia and Hurricane Katrina in the US, as well as in remote villages in Africa.

HCU at the point-of-care provides clinical information not otherwise available from the physical exam alone and facilitates caregiver/patient interaction. It allows clinicians to diagnose more confidently, save time and provide instant information for immediate treatment decisions or procedural guidance at the point of care. The clinical benefits can result in countless lives being saved. Remote offices and satellite clinics can create increased echo capacity without the need for substantial capital investment or increased operating expenses. With SonoSite's second and third generation systems now on the market, exciting new developments in HCU look set to permanently transform the face of clinical practice.

An interesting consequence of the growing adoption of HCU is the fact that it is re-energising and exciting a broad spectrum of physicians, medical students and caregivers who are oversubscribing clinical workshops and elective classes to learn how to use it. Interestingly, the availability of HCU in an institution or department is being used as a recruiting tool.

HCU In Anaesthesia

Using HCU at the point-of-care takes the guesswork out of line placements, cannulation, regional anaesthesia, and other common anaesthesia procedures.

While the use of HCU in regional anaesthesia is a relatively new application, it is already transforming the field. Anaesthetists use HCU for performing axillary, interscalene and infraclavicular brachial plexus blocks. Real time visualisation of the nerves that the physician is blocking allows him or her to place the needle accurately. In addition, the anaesthesiologist can observe the spread of the local anaesthetic around the nerves, increasing both the success of the block and reducing the volume used.

HCU in Cardiology

Point of care ultrasound systems enable the evaluation of cardiac anatomy and functionality on the spot allowing the physician faster, more confident decisions regarding patient treatment. Cardiology departments are usually involved in a wide range of procedures, ranging from cardiac surgery to pacemaker implantation. Echocardiography units, therefore, have to keep pace with the latest technological developments to remain as efficient as possible and cope with the high number of requests. Point of care echo is used to check left ventricular function and to look for major valve abnormalities in patients and features such as spectral Doppler are very useful, especially when taking a first look at valve disease. Harmonic imaging is also very important for use on hard-to-image patients (such as those with rib or lung artifacts) because an extremely high quality image is produced.

In addition, HCU can quickly and effectively identify cardiac pathologies, including valvular disease and pericardial effusions, as well as determine heart size and quantify both heart and valvular function to assess disease process and monitor progression. It also enables intima-media thickness (IMT) measurements of common carotid arteries for assessment of cardiovascular disease progression and risk and can guide cardiac surgical procedures such as coronary bypass, valve repair or replacement, and closure device placement within the septum.

In preventive medicine, HCU as an integral part of the annual physical exam could offer a solution to the early detection of asymptomatic cardiovascular disease.

HCU In Radiology

Interventional radiology is a rapidly growing area of medicine. Using imaging technology such as CT, MR and ultrasound to guide procedures means that diagnosis and treatment are both minimally invasive and highly targeted. Point of care ultrasound is being used extensively to visualise the internal jugular, femoral, subclavian and upper limb veins for venous access. Ultrasound guidance is also used to insert Hickman, dialysis, temporary and peripherally inserted central catheter (PICC) lines and for accessing arteries.

Interventional radiologists also use HCU for help with closing puncture sites. Although the majority of people respond to manual compression to close the puncture site, in some patients haemostasis fails to occur after the clinician removes pressure on the wound. These patients may form a pseudo aneurysm. With the help of ultrasound, interventional radiologists are able to diagnose a pseudo aneurysm and treat the problem.

The visualisation enabled by SonoSite's systems is having a transformational impact in medicine. It is changing how physicians assess their patients, perform procedures and manage their patient's care. HCU at the point of care is increasingly becoming the new standard for the practice of good medicine and comprehensive patient care and safety.

The SonoSite MicroMaxx system will be used in research during Xtreme Everest 2007 ascent. The expedition team, all of whom work in anaesthesia, intensive care, vascular surgery or remote medicine performed scans up to 6,400 metres (21,000 feet) on battery power and in temperatures as low as 20°C. The MicroMaxx system was operable within seconds of booting up and the images produced were very high quality. Doctors on the training expedition on Cho Oyu in the autumn of 2006 used the MicroMaxx system to diagnose a stroke suffered by a climber in another expedition, which enabled them to care for the patient until they were able to transport him to a hospital for treatment.

(Courtesy: Sonosite)