I load the sterile probe with gel on the sterile field. Therefore, the
gel as well as its package needs to be sterile. I put the sterile gel in
a sterile 10cc syringe and then load it into the toe of the probe cover.
I suppose the circulating nurse in the room could squirt a tube of KY
down into the cover, but this seems like a big mess to me. It is
difficult to deliver the gel to the toe of the probe without a syringe.
I never tried just pouring saline into the probe cover, since the gel
comes with the cover.
You are correct that everything inside the probe cover is nonsterile once
the probe is introduced. The only reason for the gel to be sterile is so
a person who is scrubbed in on the case can load the gel.
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