Estrella Yonathan, Panzlau Nathan, Vinokur Kevin, Ayala Samuel, Lin Maya, Gaeta Theodore, Melniker Lawrence, Chiricolo Gerardo, Gulec Nazey
Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Department of Emergency Medicine, RWJBarnabas Health Community Medical Center, Tom's River, NJ, USA.
Ultrasound J. 2024 Feb 7;16(1):6. doi: 10.1186/s13089-023-00347-0.
Physicians frequently use point-of-care ultrasound for intravenous access and bloodwork in the ED. Recently, AIUM and ACEP released recommendations on ultrasound-guided peripheral intravenous lines (USPIVs), but there are no agreed upon standardized policies. We sought to determine whether the use of sterile-covered transducers (SCT) decreases the rate of contamination when compared to uncovered transducers (UCT) after standard low-level disinfection (LLD).
This is a randomized control trial comparing contamination rates of US transducers between SCT and UCT after their use for USPIV by the vascular access team, also known as the "PICC" team, over a 3-month period. A sample of admitted patient with an USPIV order were included and randomized to SCT (experimental) or UCT (control) arms. Transducers were swabbed and inserted into the SystemSURE Plus Adenosine Triphosphate (ATP) Luminometer to calculate Relative Light Units (RLU). We performed a cost analysis of requiring sterile covers for USPIVs.
The UCT and SCT arms contained 35 and 38 patients, respectively. The SCT group had a mean of 0.34 compared to the UCT group mean of 2.29. Each sterile cover costs $8.49, and over 3000 USPIVs are placed annually by the "PICC" team.
Contamination rates were similar among the UCT and SCT groups after LLD. 254 inpatient USPIVs are performed monthly, not including failed attempts or covers used in the ED where USPIV placement is an essential part of ED workflow. This study suggests that the use of SCT does not significantly affect transducer contamination rates. These findings question burdensome regulatory hospital policies that are not evidence-based.
医生在急诊科经常使用床旁超声进行静脉穿刺和血液检查。最近，美国超声医学学会（AIUM）和美国急诊医师学会（ACEP）发布了关于超声引导下外周静脉置管（USPIV）的建议，但尚未达成统一的标准化政策。我们试图确定与未覆盖探头（UCT）相比，使用无菌覆盖探头（SCT）在标准低水平消毒（LLD）后是否能降低污染率。
这是一项随机对照试验，比较血管通路团队（也称为“PICC”团队）在使用USPIV 3个月后，SCT与UCT的超声探头污染率。纳入有USPIV医嘱的住院患者样本，并随机分为SCT（试验组）或UCT（对照组）。对探头进行擦拭，然后插入SystemSURE Plus三磷酸腺苷（ATP）发光计中计算相对光单位（RLU）。我们对USPIV使用无菌套的成本进行了分析。
UCT组和SCT组分别有35例和38例患者。SCT组的平均值为0.34，而UCT组的平均值为2.29。每个无菌套成本为8.49美元，“PICC”团队每年放置超过3000个USPIV。
LLD后，UCT组和SCT组的污染率相似。每月进行254例住院患者USPIV置管，不包括失败的尝试或在急诊科使用的套，在急诊科，USPIV置管是急诊工作流程的重要组成部分。本研究表明，使用SCT不会显著影响探头污染率。这些发现对医院那些缺乏循证依据的繁重监管政策提出了质疑。
