What we are seeing right now is involvement of both lungs with basically patchy findings. What is distinctive is typically ultrasonographic B lines, wide bands of hyperechoic artifact that are often compared to the beam of a flashlight being swung back and forth. In addition, if there is a significant consolidation, you may see hepatization of the lung. Right now, in what we are seeing, pleural effusions seem to be very uncommon.
HCB News: What type of US equipment or features are best for COVID-19 applications?
First, starting with the transducer, typically a phased array is used for this exam of the lung. Remember, this is a highly infectious patient, so ideally the device itself should have fewer buttons and knobs to disinfect, touchscreens are preferred, smooth surfaces that are easy to clean are preferred. Any peripherals that are on the device should be disconnected so that there are fewer things to wipe down and clean. Those are the most important elements.
HCB News: What are the special challenges around infection control for ultrasound equipment when treating patients with COVID-!9?
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The device needs to be properly cleaned before the clinician enters the room—a complete wipe-down with a disinfectant agent, plus proper transducer probe covers, as well as covering the entire system with a sterile cover or drapes. The key idea is to keep everything covered to minimize contact with infectious droplets from the patient. Then likewise, after the exam, everything has to be removed and cleaned again. In an ideal situation, a department that has multiple devices would have an ultrasound device dedicated to COVID-19 or suspected COVID-19 cases to minimize the possibility of cross-contamination. If you were a patient going to the emergency department with suspected appendicitis, would you want to be imaged with a machine that had previously been used on a COVID-19 patient? That is why hospitals without multiple devices are asking for additional devices to be reserved for use with COVID-19 patients.
HCB News: What is the recommended protocol for cleaning & disinfecting US equipment after an exam on a COVID-19 patient?
Some manufacturers have device-specific resources to help users identify appropriate cleaners and disinfectants that have been evaluated for compatibility for their systems. For example, we have the SonoSite Cleaner and Disinfectant Tool on our website as well as information on COVID-19 infection control resources and educational content on lung ultrasound to support healthcare providers who are preparing for the challenge of protecting providers and patients against SARS-CoV-2, the virus behind COVID-19. The EPA has recently published List N: Disinfectants for Use Against SARS-CoV-2, which is another helpful resource to identify appropriate products.