Minimizing infection risk when using lung POCUS with COVID-19 patients

26th Nov 2020

Point-of-care ultrasound (POCUS) is extremely helpful for evaluating patients with suspected COVID-19. However, you need to ensure that you’re using the ultrasound safely. This involves minimizing the risk of both clinicians and patients inadvertently becoming infected.

There are four key steps that can be used to minimize infection risk and maintain excellent infection control precautions:

  1. Choosing your ultrasound system
  2. Choosing who should perform the scan
  3. Sterilizing your equipment 
  4. Performing the ultrasound scan


Step One: Choosing your ultrasound system

If you have multiple machines in your clinical area, pick one to be used exclusively for the evaluation of patients with suspected COVID-19.

If you have a handheld ultrasound system, consider using the handheld unit for scanning COVID-19 patients, rather than a larger cart-based ultrasound machine. 

Handheld ultrasound devices are perfect for COVID-19 scans because they are small enough to be covered completely with a probe cover. As well, there is no internal fan to promote aerosolization.

However, if you anticipate needing to use your device for procedures such as peripheral intravenous line, central line placement, or thoracentesis, you may want the flexibility of a cart-based system that has multiple transducers.

If you’re fortunate to be able to designate one handheld and one larger cart-based ultrasound for patients with suspected COVID-19, that’s the best of both worlds! 


Step Two: Choosing who should perform the scan 

When considering who should perform the scan, choose the most experienced operator. In general, be sure to minimize a patient’s contact with other patients and the time the operator spends in the room with the patient. 


Step Three: Sterilizing your ultrasound equipment

First, strip off all the junk that has accumulated on the machine such as IV supplies, manuals, and gel bottles. If you’re using a handheld device, this is easier. 

For an aerosolizing procedure or a procedure with a high-risk patient, make sure to cover the probe and cord with a plastic sheath. If it’s not a procedure, the sheaths don’t have to be sterile. 

For an aerosol-generating procedure, drape the machine with a plastic cover (but check that your controls still work). 

Doctor in personal protective equipment (PPE) holding a probe covered in a plastic sheath beside ultrasound machine covered in a plastic sheath. Cartoon.

Figure 1. Proper sterilization includes covering the probe and machine with plastic sheaths to reduce the aerosolization of the virus. 

If they are available, stock up on single-use gel packets, rather than bottles, for the procedures. 


Step Four: Performing the lung ultrasound scan

Now it’s time to perform your scan! 

During the lung ultrasound procedure, consider standing behind the patient—particularly if they are coughing, tachypneic, or if they have difficulty staying masked. 

Doctor in personal protective equipment (PPE) holding a sheathed probe and standing behind a sick patient with COVID-19 in bed. Cartoon.

Figure 2. Stand behind your patient when performing the lung ultrasound procedure if they are coughing, tachypneic, or having difficulty staying masked. 

After the scan, exit the patient room (if you’re in an enclosed space), clean your gloved hands, take off any cover or drape, and use an approved wipe to clean the transducer and machine. 

Always check for nationally and institutionally approved wipes and cleaners. 

Ensure that the cleaner has sufficient dwell time or wet time, where the surfaces are damp to make sure that viral particles are destroyed.

You don’t need high-level disinfection when scanning intact skin. If you’re scanning over broken skin or using an endocavitary transducer, then you need high-level disinfection. 


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Recommended reading

  • Dargent, A, Chatelain, E, Kreitmann, L, et al. 2020. Lung ultrasound score to monitor COVID-19 pneumonia progression in patients with ARDS. PLoS One15: e0236312. PMID: 32692769
  • Kim, DJ, Jelic, T, Woo, MY, et al. 2020. Just the facts: Recommendations on point-of-care ultrasound use and machine infection control during the coronavirus disease 2019 pandemic. CJEM22: 445–449. PMID: 32268930
  • Long, B, Brady, WJ, Koyfman, A, et al. 2020. Cardiovascular complications in COVID-19. Am J Emerg Med38: 1504–1507. PMID: 32317203
  • Mongodi, S, Orlando, A, Arisi, E, et al. 2020. Lung ultrasound in patients with acute respiratory failure reduces conventional imaging and health care provider exposure to COVID-19. Ultrasound Med Biol46: 2090–2093. PMID: 32451194
  • Pare, JR, Camelo, I, Mayo, KC, et al. 2020. Point-of-care lung ultrasound is more sensitive than chest radiograph for evaluation of COVID-19. West J Emerg Med21: 771–778. PMID: 32726240
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