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The Importance Of Proper Sterile Technique During Vascular Access
Abstracts Methods: Completed to date is: a systematic review of the literature. a two round Delphi Study that sought consensus around the critical parameters in the assessment of perforator veins and the design of a reliability/validity assessment instrument. The second round of the study was modified in response to the first round responses. A total of 12 responded to both rounds of the study (5 vascular surgeons and 7 vascular sonographers). Results: The literature review revealed a paucity of material in the literature examining the reliability and validity of sonographer’s measurements. This lack is across sonography in general, including for the examination for CVI and perforator veins. It was expected the responses to the Delphi study would emphasise the traditional parameters of perforator location, diameter and competence and this was the case. A novel finding is that those practicing endovascular interventions were also interested in tortuosity of the perforator. A final data collection instrument was developed around these responses and this will be applied to the ultrasound examination of a series of patients with the first and second examiners double blinded to the result. References: 1. Eidson Iii, J. L., & Bush, R. L. (2010). Diagnosis and Current Management of Incompetent Perforator Veins. Seminars in Vascular Surgery, 23(2), 113-117. doi:http://dx.doi.org/10.1053/ j.semvascsurg.2010.01.007. 2. Neglen, P., & Raju, S. (1992). A comparison between descending phlebography and duplex Doppler investigation in the evaluation of reflux in chronic venous insufficiency: a challenge to phlebography as the “gold standard”. Journal of vascular surgery, 16(5), 687. 3. Zygmunt, J. A. (2014). Duplex ultrasound for chronic venous insufficiency. The Journal of invasive cardiology. The Importance Of Proper Sterile Technique During Vascular Access Kevin Rooker CIVCO Medical Solutions, Coralville, Iowa, USA The increase in incidence and cost of catheter-related bloodstream infections (CRBSI) continues throughout the world. Contaminated ultrasound gel used during ultrasound guided central venous catheter (CVC) placement has been associated with outbreaks in multiple countries, leading to numerous complications including patient death. Proper preparation of the ultrasound probe, including the use of an appropriate validated probe cover or sheath, the proper use and removal of sterile ultrasound gel and proper probe disinfection techniques all can lead to a reduction in the incidence and cost associated with CRBSI. References: 1. Westerway S, Basseal J, Brockway, Hyett A, Carter D. “Potential Infection Control Risks Associated With Ultrasound Equipment A Bacterial Perspective” Ultrasound in Med & Biol., Vol 43, No 2, 421-426 2017. 2. Shaban R, et al “Outbreak of health care-associated Burkholderia cenocepacia bacteremia and infection attributed to contaminated sterile gel used for central line insertion under ultrasound guidance and other procedures” American Journal of Infection Control 45 (2017) 954-8. 3. Abdelfattah R, Al-Jumaah S, Al-Qahtani A, Al-Thawadi S,.Barron I, Al-Mofada S. “Outbreak of Burkholderia cepacia bacteraemia in a tertiary care centre due to contaminated ultrasound probe gel” Journal of Hospital Infection 98 (2018). 4. https://www.aium.org/accreditation/Guidelines_Cleaning_Preparing.pdf.
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5. Westerway SC, Basseal JM. Advancing infection control in Australasian medical ultrasound practice. Austral J Ultrasound Med 2017; 20:26 29. 6. Gottlieb M, Sundaram T, Holladay D, Nakitende D. Ultrasoundguided peripheral intravenous line placement: a narrative review of evidence-based best practices. West J Emerg Med 2017; 18:1047.
SESSION 1D: YOUNG INVESTIGATORS Addition of reliability measurement index to point shear wave elastography: Prospective validation via diagnostic performance and reproducibility Hyo-Jin Kang, Jae Young Lee, Ljin Joo, Joon Koo Han Seoul National University Hospital, Jongno, Seoul, South Korea Introduction: To investigate the clinical value of the reliability measurement index (RMI), which is here newly added to point shear wave elastography (pSWE) in assessing liver stiffness. Methods: Forty-nine patients were prospectively enrolled in this IRB approval study and underwent both pSWE providing RMI (range, 0.0 1.0) and transient elastography (TE) prior to hepatic surgery. Liver stiffness (LS) measurements were repeated until 10 LS values with RMI0.7 were obtained by each of two radiologists. Interclass correlation coefficients (ICCs) between the median of the first two to nine measurements (as determined by RMI values of 0.0 [LS-RMI 0.0], 0.4 [LS-RMI 0.4] and 0.7 [LS-RMI 0.7]) and that of a consecutive 10 measurements (LS-REF) were obtained. Minimum number of measurements to attain ICC0.95 and high interobserver agreement (ICC0.90) were determined for each RMI cutoffs. Diagnostic performance of reduced number of LS measurement for identifying liver fibrosis and correlation coefficients between LS measurements and the TE, METAVIR and necroinflammatory activity were calculated. Results: Upon comparison with LS-REF, a minimum of seven LS-RMI 0.0, five LS-RMI 0.4, and three LS-RMI 0.7 measurements were required to obtain ICC0.95 with a high interobserver agreement (ICC0.90). Diagnostic performance for differentiating liver fibrosis did not differ (all Ps>0.05) using these reduced number of LS measurements. Significant correlations were found between the medians of these reduced number of LS measurements and TE (all Ps<0.001) and METAVIR (all Ps<0.001) scores. Conclusion: RMI helped to improve reliability and reduce the number of LS measurements while maintaining the diagnostic performance of pSWE. High Frequency Ultrasound in Aesthetic Dermatology. Novel Research For the Use of 18 MHz ShearWave Elastographyfor Pre and Post Therapy Assessment. Pre Clinical Trials of Collagen Fillers within the Dermal and Subdermal Layers of the Skin Kathryn K. Malherbe Lavita Womens Wellness Centre, Rietvalleirand, Gauteng, South Africa Ultrasound elastography (USE) is an imaging technology sensitive to tissue stiffness and in recent years’ technology has enabled methods to add quantitive measurements of tissue stiffness. The study included female volunteers referred to a local aesthetic centre for use of hyaluronic fillers in the periorbital region. Patients included in the study would be over the age of 35 years with no previous history of scarring, allergy, atopy, trauma or subcutaneous skin disorders. All participants were subject to ultrasound evaluation by means of 18 MhZ linear probe Hitachi Aloka Arietta S70 to assess the skin in the periorbital region bilaterally.
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5. Westerway SC, Basseal JM. Advancing infection control in Australasian medical ultrasound practice. Austral J Ultrasound Med 2017; 20:26 29. 6. Gottlieb M, Sundaram T, Holladay D, Nakitende D. Ultrasoundguided peripheral intravenous line placement: a narrative review of evidence-based best practices. West J Emerg Med 2017; 18:1047.
SESSION 1D: YOUNG INVESTIGATORS Addition of reliability measurement index to point shear wave elastography: Prospective validation via diagnostic performance and reproducibility Hyo-Jin Kang, Jae Young Lee, Ljin Joo, Joon Koo Han Seoul National University Hospital, Jongno, Seoul, South Korea Introduction: To investigate the clinical value of the reliability measurement index (RMI), which is here newly added to point shear wave elastography (pSWE) in assessing liver stiffness. Methods: Forty-nine patients were prospectively enrolled in this IRB approval study and underwent both pSWE providing RMI (range, 0.0 1.0) and transient elastography (TE) prior to hepatic surgery. Liver stiffness (LS) measurements were repeated until 10 LS values with RMI0.7 were obtained by each of two radiologists. Interclass correlation coefficients (ICCs) between the median of the first two to nine measurements (as determined by RMI values of 0.0 [LS-RMI 0.0], 0.4 [LS-RMI 0.4] and 0.7 [LS-RMI 0.7]) and that of a consecutive 10 measurements (LS-REF) were obtained. Minimum number of measurements to attain ICC0.95 and high interobserver agreement (ICC0.90) were determined for each RMI cutoffs. Diagnostic performance of reduced number of LS measurement for identifying liver fibrosis and correlation coefficients between LS measurements and the TE, METAVIR and necroinflammatory activity were calculated. Results: Upon comparison with LS-REF, a minimum of seven LS-RMI 0.0, five LS-RMI 0.4, and three LS-RMI 0.7 measurements were required to obtain ICC0.95 with a high interobserver agreement (ICC0.90). Diagnostic performance for differentiating liver fibrosis did not differ (all Ps>0.05) using these reduced number of LS measurements. Significant correlations were found between the medians of these reduced number of LS measurements and TE (all Ps<0.001) and METAVIR (all Ps<0.001) scores. Conclusion: RMI helped to improve reliability and reduce the number of LS measurements while maintaining the diagnostic performance of pSWE. High Frequency Ultrasound in Aesthetic Dermatology. Novel Research For the Use of 18 MHz ShearWave Elastographyfor Pre and Post Therapy Assessment. Pre Clinical Trials of Collagen Fillers within the Dermal and Subdermal Layers of the Skin Kathryn K. Malherbe Lavita Womens Wellness Centre, Rietvalleirand, Gauteng, South Africa Ultrasound elastography (USE) is an imaging technology sensitive to tissue stiffness and in recent years’ technology has enabled methods to add quantitive measurements of tissue stiffness. The study included female volunteers referred to a local aesthetic centre for use of hyaluronic fillers in the periorbital region. Patients included in the study would be over the age of 35 years with no previous history of scarring, allergy, atopy, trauma or subcutaneous skin disorders. All participants were subject to ultrasound evaluation by means of 18 MhZ linear probe Hitachi Aloka Arietta S70 to assess the skin in the periorbital region bilaterally.