Well my first question is why is the sonographer handling the probe? When I do ultrasound guided access for thermal ablation or for sclero or for pseudoaneurysm injection I am sterile and the probe is covered with the sterile sleeve, I am the only one handling both the probe and the needles. If I stick myself I have no one else to blame.  I learned long ago that ultrasound guided access is a bimanual procedure, i.e., the operator needs to have both the probe and the needles in hand.
Joseph R. Schneider, M.D., Ph.D., F.A.C.S., R.V.T., R.P.V.I.
Vascular Surgery and Interventional Radiology Partners/VSIR

On Oct 5, 2015, at 8:30 PM, Michael Cuzzilla <[log in to unmask]> wrote:

The widespread use on EVLA and UGS has resulted in a massive increase in sonographer exposure to the risk of needle stick injuries. The policies and protocols to protect all staff not just sonographers, vary between institutions that I have worked in (most are small private practices) where occupational health and safety is not always a priority.  Surprisingly, in my experience, it is the surgeons who are acutely aware of the risk of needle stick injuries when operating that seem the most blasé.  During UGS some doctors reuse the same needle and syringe for the whole procedure whilst others change the needle and syringe with every puncture. In this country no one that I know of uses specifically made single-use Safety needles and syringes and I guess the major concern is that using these or opening and using new conventional ones for each puncture is a waste of time and money.
As my hand is holding the probe, I beg to differ.  Multiple uses of the same needle and syringe means that after the initial injection, sonographers performing ultrasound guidance are at increasing risk with every subsequent puncture. From a negative clinical viewpoint, any blood in the needle hub or syringe makes the foam less potent as the drug it is immediately deactivated on contact with blood, i.e. foam should not be salmon pink when its injected.  I believe that single-use should be mandatory but I am keen to know how everyone else deals with this plus any thoughts on dealing with tumescence anaesthetic. Im sure the doctors would be more concerned if they held the probe themselves as many phlebologist do but that would put me out of a job.  I could always use a mesh glove like the ones butchers use or is there a detachable shield that anyone has come across?
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Michael Cuzzilla
Technical Director
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Kuring-Gai Vascular Ultrasound
Suite G06
Ground Floor
10 Edgeworth David Avenue
HORNSBY NSW 2077 Australia
P +61 2 9477 7177 F +61 2 9477 6238
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