Discussion with Hammond Spencer, RDCS, PE

Supervisor Echocardiology - Providence St Vincent Medical Center

Friendly medicine professional standing in the clinic

Q. What is productivity mean to you when you are with the patient?

Productivity is important but more so in the acute care setting (hospital) where you may have less cooperative patients, other clinicians needing to see the patient, or time sensitive findings.

Q. How important it is for you to stay safe, especially during time like this? What does it mean to you and your patient?

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Q. Do you think it is important to get the ultrasound done with fewer touches (or fewer touchpoints) when you are with the patient, for your safety and for your patient’s safety?

Safety has taken on a new meaning during the COVID-19 pandemic. It is extremely important to reduce the amount of time necessary to answer the clinical question without exposing yourself or other patients to the coronavirus.

Q. Do you think you can achieve this safety by using Lumason? And how?

When performing an exam on a patient that is under isolation precautions it is important to remove any unnecessary equipment, cables, transducers, supplies, and linen from the ultrasound machine. This reduces the number of items that need to be sanitized and also reduces the potential to transmit organisms to other patients.  We have removed vial shakers from our ultrasound machines as part of our safety initiative.  

Having access to Lumason,  which does not require special equipment, has allowed us to continue to utilize contrast when needed without additional equipment or staff that might would otherwise bring activated vial into an isolation room. Additionally, there is concern with other agents of returning unused product to a refrigerator to co-mingle with other vials.

Q. What do you think when you want to use the contrast agent and have to leave the room and the patient?

It is inefficient when you have to leave a patient to retrieve a contrast agent or active an agent. In an inpatient setting, due to having repositioned them for scanning purposes there is some risk of the patient moving on their own and  pulling on IV lines etc. Also, when you return, there can often be other healthcare providers who have entered the room to do their work, often times delaying the completion of the exam.

Q. What are your thoughts about the use of contrast agent in the COVID-19 era?

By all accounts COVID-19 is far more contagious than the typical flu and there are suggestions of the virus living on hard surfaces for many days. In this light, I believe there should be more emphasis placed on reducing the number the number of items a provider must handle in order to provide the care needed.  

As an industry (echo) we should scrutinize how we are handling our contrast media. It is common practice in large inpatient facilities for sonographers to carry vials of contrast in their pockets for the day. This practice should stop as it is unlikely that the care provider is practicing proper hand hygiene in the middle of their exam when retrieving vials from their scrub pockets which potentially facilitates the cross contamination of other contrast vials and ultimately provides a possible means of spreading pathogens to additional patients.