General Info (1)

Universal Precautions

Commonly called Standard Precautions; established by the Center for Disease Control to prevent infection and confine germs.

Standard Precautions Primary Purpose

Protects both the patient and the caregiver from infection.

Standard Precautions Approach

Treating all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV, and other blood-borne pathogens.

Personal Protective Equipment (PPE)

Specialized clothing or equipment worn by an employee for protection against a hazard, including gowns, goggles, and masks.

Engineering and Work Practice Controls

Methods used to limit exposure, such as sanitizing equipment between patients and using probe covers during endocavity ultrasound.

Probe Sanitization Requirement

Must be performed after each patient to maintain hygiene.

Linen and Pillowcase Protocol

Should be changed after each patient to prevent cross-contamination.

PPE Application Order

Wash hands, put the gown on first, then the mask, then the goggles, and end with the gloves.

Hand Hygiene - Antibacterial Soap

Must be used with extra care to nails, knuckles, and between fingers.

Hand Hygiene Duration

Wash for $20+$ seconds, assisted by saying the ABCs or singing Happy Birthday.

Contamination Protocol

Immediately wash the area with soap and water, notify supervisor, and report to occupational health to file an exposure report.

Glove Indications

Wear when there is potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment.

Jewelry Protocol for Gowns

Remove all watches and jewelry before putting on a gown.

Gown Removal Technique

Remove gloves, untie strings, pull forward from shoulders using neck strings, grab inside shoulder seams, pull off arms, and turn inside out.

Face Mask Indication

Protects the nose and mouth during contact with respiratory secretions and sprays of blood or body fluids.

Face Mask Tie Placement

Tie the upper strings over the ears and towards the top of the back of the head.

Face Mask Removal Sequence

Remove gloves first, untie bottom strings, then untie top strings.

Eye Protection Indication

Wear goggles or face shields during contact with respiratory secretions and sprays of blood or body fluids.

Personal Eyeglasses Regulation

Personal eyeglasses and contact lenses are NOT considered adequate eye protection.

Goggle Removal Technique

Touch the sides of the goggles to remove and discard; do not touch the front.

Contact Precautions Usage

Protects against germs in patients with stool incontinence, draining wounds, uncontrolled secretions, or skin lesions.

Enteric Contact Precautions Examples

Used for patients with C. difficile, rotavirus, or norovirus.

Wound and Skin Contact Precautions Examples

Used for patients with MRSA, VRE, scabies, and impetigo.

Droplet Precautions Purpose

Protects others from germs in the patient's nose, mouth, throat, and lungs.

Droplet Precautions Indications

Used for patients with suspected infection who are sneezing, coughing, or spitting.

Droplet Precautions - Pathogens

Includes pneumonia, influenza, adenovirus, mumps, rubella, meningitis, and bordetella pertussis.

Droplet Precautions - Mask

Wear a facemask (surgical mask) for close contact with the patient.

Droplet Precautions - Patient Movement

The patient should wear a facemask when exiting the exam room.

Airborne Precautions Definition

Strict isolation to prevent spread by contact or airborne transmission of highly contagious diseases.

Airborne Precautions - Pathogens

Required for tuberculosis, measles, chickenpox (varicella), and shingles.

N-95 Respirator

A fit-tested disposable respirator required for entry into a room under airborne precautions.

Airborne Precautions - Respirator Protocol

Put the respirator on before entering the room and remove it after exiting.

Protective Environment Precautions

Also known as reverse protective isolation; protects patients with extremely impaired immune systems or recent transplants.

Reverse Isolation Equipment Protocol

Equipment should be cleaned and disinfected before and after leaving the patient room.

AIUM - Prudent Use

Do not perform ultrasound studies without a valid medical reason.

AIUM Benefit-Risk Ratio

The potential benefit of the ultrasound exam should always outweigh the risk of exposure.

AIUM Study Duration

Do not prolong studies without reason; minimize exposure time for a diagnostic exam.

ALARA Principle

Acronym for As Low As Reasonably Achievable; use minimum output power and highest receiver gain for optimal images.

Invasive Procedures - Sterile Technique

Required for intraoperative ultrasound, intravascular ultrasound, angioplasty, and catheter-based procedures.

PT and INR Levels

Assessed prior to most invasive procedures to determine the blood's clotting ability.

Normal INR Value

Range of $0.9$ to $1.3$ for a healthy individual.

Blood Thinner INR Range

The target INR for a patient on blood thinners is typically $2$ to $3$.

Informed Consent Requirement

Mandatory for all invasive procedures and stress testing.

Informed Consent Contents

Must list the procedure and potential associated risks and complications.

Informed Consent Signing Timing

Must be signed PRIOR to the procedure AFTER a physician answers any questions/concerns.

Informed Consent Implication

Indicates the patient has an understanding of the procedure, complications, and expected outcomes.

Informed Consent: Mental Status

The patient must be of sound mind and have a full understanding of the information presented.

Informed Consent Signatory Restrictions

Patients under $18$, those not of sound mind, or those with poor English should have a guardian or HIPAA-approved family sign.

Revocation of Consent

Can be revoked by the patient at any time for any reason.

Discontinuation of Procedure

If consent is revoked, the procedure should stop at a point that maintains patient health and safety.

Sterile Field Integrity

All items and personnel in a sterile field must be sterile.

Sterile Field Creation Timing

Sterile packages or fields are opened or created as close as possible to the time of actual use.

Moisture and Sterility

Moist areas are not considered sterile.

Sterile Field Contamination

Contaminated items must be removed immediately from the sterile field.

Sterile Gown Definition

Considered sterile only in the front, from chest to waist, and from the hands to slightly above the elbow.

Sterile Table Definition

Tables are considered sterile only at or above the level of the table.

Sterile Personnel Movement

Personnel should pass each other back to back when moving around the exam room.

Sick Personnel Protocol

Personnel with colds should avoid working while ill or apply a double mask.

Outer Inch of Sterile Field

The edges of sterile areas (generally the outer inch) are not considered sterile.

Sterility Uncertainty Rule

When in doubt about sterility, discard the item and begin again.

Expired Sterilization Dates

Items with expired sterilization dates should not be used.

Tray Opening Time

Trays and instruments should be opened at the start of the procedure, NOT before.

AHA CPR Ratio - Single Rescuer

$30$ compressions to $2$ breaths for adults and children.

AHA CPR Ratio - Multiple Rescuers

$15$ compressions to $2$ breaths for children and infants.

CPR Compression Rate

At least $100$ compressions per minute for adults and children.

Choking - Heimlich Maneuver Position

Standard for adults; if pregnant, position hands above the uterus at the base of the sternum.

Syncope Management

Place the patient in the supine position and elevate the legs.

Vasovagal Reaction Definition

A drop in heart rate and blood pressure caused by stress, trauma, or excessive standing; often leads to syncope.

Anaphylactic Reaction Symptoms

Hives, feeling flush, nausea, vomiting, and shortness of breath.

Sonography Ergonomics

Designing and arranging things so the Sonographer interacts most efficiently and safely with patients and equipment.

Work-Related Musculoskeletal Disorders (WRMSD)

Injuries that protocols are designed to prevent; common in the shoulder and neck for Sonographers.

Sonographer Injury Causes

Reaching across a patient for extended periods or stretching for system controls.

Arm Abduction Limit

Should be limited to a small angle to minimize potential injury.

Sonographer Reach Limit

Limit reach to $30cm$ or less to minimize injury.

Weight Capacity Requirement

Sonographers must be able to lift or push $50lbs$.

Adjustable Exam Tables

Preferred so the Sonographer can sit during the exam.

Adjustable Chairs

Should support the natural spinal curvature to reduce spinal disc compression.

Standing Sonographer Posture

Weight should be balanced on both feet to prevent hip and back injuries.

Monitor Positioning

Should be level with the line of sight to allow for a neutral neck position.

Transducer Grip

Should be held in the hand and not tightly gripped with the fingers.

Wrist Angle for Scanning

The wrist should be in a neutral position or flexed/extended at an angle less than $15$ degrees.

Proper Ergonomics Support Tools

Adjustable consoles, foot pedals, and remote control image capture.

Patient Scheduling Data Requirements

Name, DOB, ordering physician, exam type, reason for exam, and prior history at the facility.

NPO Scheduling

TEE studies and Stress Echoes should be scheduled in the morning, especially for diabetic patients.

Repetitive Injury Prevention

Try not to schedule the same type of exam back to back.

TTE Exam Preparation

Review the indication, possible cardiac findings, and prior reports.

TTE Patient Verification

Use birth date, wristband, or patient chart; ask the patient to confirm name and DOB.

Inpatient Verification

Use the patient wristband to verify name and medical record number.

Unconscious Patient Verification

Confirm identity by contacting their nurse.

TTE Explanation for Children

Provide an easy-to-understand explanation and demonstration of the probe and gel.

TTE Communication for Dementia

A family member may be present to make the patient more comfortable; check with the nurse for communication tips.

TTE History Interview

Interview regarding medical history and any cardiac-related signs or symptoms.

Systemic Blood Pressure Assessment

Obtain while the patient is in a resting state before the exam.

MRN (Medical Record Number)

A facility-specific identifier; prohibits the use of social security numbers as identifiers on imaging exams.

U.S. Law on Social Security Numbers

State and federal regulations prohibit using SSNs as identifiers on medical records.

Transducer Selection Criteria

Higher frequencies are used for thinner or smaller patients.

Preset Activation

Inappropriate presets can degrade the exam and extend the exam time.

TTE Patient Positioning

Patient is instructed to lie on their left side with EKG leads attached.

EKG Rhythm Record Setting

If the rhythm is irregular, set the machine to record $3$ to $5$ beat clips.

Transducer Cable Positioning

Never place around neck/shoulders; wrap around wrist or use probe holders.