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Firstly, a referral is a legal document and the request should be followed, not replaced with a scan that is going to be less appropriate.
They are also not the same scan. NT and NB information are very important and not replaced by the blood test. They are part of the anatomy of a fetus and so should be assessed at this stage. Normal blood results can be false negative. Absent/hypoplastic NB and/or thickened NT will still prompt further testing regardless of blood results.
If things like this are missed because an inappropriate scan was done, you leave yourself open to legal liability and litigation.
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Thank you for your question,
To ensure accreditation compliance, we recommend reviewing the current DIAS guidelines (accessible via the link below). This will allow you to tailor your department's procedures to these standards.
DIAS Guidelines: DI2104 Disinfection Requirements for Reusable Semi-Critical Medical Devices
Additional valuable resources that will also provide assistance include flowcharts from ASUM and BMUS, along with the Australian Guidelines for the Prevention and Control of Infection in Healthcare, available at NHMRC's Infection Control Guidelines (February 2020).
For more personalized guidance, we suggest that you consider consulting with your local infection control or infectious diseases departments. They may be able to offer specific assistance tailored to your facility's needs.
There are multiple brands/manufactures that produce consumables that are suitable. If you search "high level disinfectants" for ultrasound it will provide you with links to the specific companies and their products.
Best regards,
Vascular SIG
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Thank you for your question.
The guideline is specifically for patients in the mid trimester scan, ie. morphology. In the guideline a specific subgroup for third trimester patients was not included, as there is limited clinical value in performing CL measurements after 24 weeks. Therefore a CL measurement (either TV or TA) is not required in third trimester, unless specifically requested by the referring doctor or as per your radiologist.
If a patient presents to you in third trimester (these would usually be surveillance), to have a CL assessment at the request of the referrer, it is usually appropriate to do a TV scan, as long as it is not contraindicated (ie. Preterm labour).
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Thanks for the question, Royal Darwin!
We got a very enthusiastic response from the group which I'm sure will help.
Every member of the group is in agreement that retrograde flow must be demonstrated in the ovarian veins for them to be labelled incompetent. This is in keeping with the latest classification by the American Vein & Lymphatic Society (Meissner et al 2021).
That isn’t to say diameter isn’t important. The above paper found >70% positive predictive value for reflux in ovarian vein with diameters ranging from 0.5-0.8cm. In actual practice, the overall experience of the vascular SIG is that ovarian veins with a diameter >0.5cm are often incompetent.
As far as protocol is concerned, having the patient well hydrated is definitely the way to go. Patients can be scanned in the supine position – if views of the ovarian veins are equivocal then scanning patient in a semi recumbent or erect position can help.
As part of this scan, you’ll also want to rule in/out left renal vein (Nutcracker)and left common iliac vein compression (May Thurner) as well as performing a full assessment of the IVC and bilateral iliac veins to assess for patency, flow direction and waveform.
One of the SIG members suggested this would be a great topic for a travelling workshop in Darwin – would that be of interest to you?
Thanks
Vasc SIG
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There are no specific measurements for the lateral ventricles at the 12-13 week scan. Instead, Using a subjective approach to assess ventricular anatomy. This is consistent with current research as no systemic approaches are currently used.
Ventriculomegaly and its prognosis is highly dependent on the underlying cause. It may be associated with both chromosomal and non chromosomal causes. Development may occur later in the pregnancy just as ventriculomegally may resolve as the pregnancy progresses.
Currently, suspected isolated ventriculomegaly at the 12 - 13 week scan requires further investigation by fetal neurosonography or tertiary referral.
Attached are some relevant articles.
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Thank you for your question.
This is a very tricky scenario. ASA has no "standpoint" on the topic.
However, we would suggest speaking to your radiologist who is reporting and following your local guidelines.
A strategy to approaching these requests would be to speak to your patient, let them know what normal practice is and ensure your ask them if you can check FHR.
We cannot do anything without patient consent. If the patient declines any imaging of the fetus, please ensure you are clear on your worksheet and document that the patient declined.
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Thanks for your question regarding GCA. It brought with it a unanimous answer from three members of the vascular SIG. The points made where that there are no official guidelines for assessing for GCA in Australia and yes, the axillary artery should definitely be included as part of the study as GCA has been well documented in this vessel.
Its more the Rheumatology space that investigates GCA - please find the attached paper from EULAR.
Thanks
Vasc SIG
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Sorry , for the delay but after asking around I haven't found a supplier of vertical arm slings. All the best
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Hi, apologies for the delayed response.
We fast for HCC screens for the usual 4 hours to reduce bowel gas, but also if they are going to have a liver elastography as well. Non fasting artificially increases elastography values.
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Certificate of Capacity is issued by the nominated treating doctor (NTD) once the person has reported the problem to management and a WorkCover insurance claim has been raised.
You should report incapacity to your management?
ASA has no advise on examples of Certificate of Capacity as such. Light duties are prescribed once the person has sought medical advice and reported through the proper channels.
A hand therapist may help via a thumb brace for support. Cortisone injection also may be of benefit if synovitis is present in the thumb joints. Best to seek advice from a GP or physio.
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Hi Matt,
I am making sure that this thread is working.
Your question: Is there anyway you could provide me with details on the nurse training that was provided for cannulation? Were there any medico-legal issues you had to navigate in terms of sonographers actually being able to needle in Victoria?"
The training is fairly informal. We do a short session on cannulation theory, and practising with a phantom, and then do some supervised cannulations, and then get assessed. For ultrasound guided cannulation it is also a short session with one of the radiologist. It is not very involved, and no medico-legal issues, and in fact radiographers can do an ultrasound guided cannulation short course. We are happy for you to ring us at RMH if you want any more information.
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Hi Matt, it was probably myself talking about cannulation . Some Sonographers can cannulate at RMH , and have done a short course with the nursing educators, then a few supervised cannulations before they are signed off to do it themselves . This is very easy . We usually have our nurses do it though, as this gives us time to chat to the radiologist and prepare the contrast . Let us know if you have any more Ceus queries .
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Thank you for your question.
There are many reasons why a formal ultrasound may be requested in cases of suspected FDIU.
National, and many international guidelines on management of stillbirth state that evaluation following a stillbirth include fetal autopsy, gross and histologic exam of the placenta, umbilical cord and membranes, and genetic studies. A formal scan could assist with confirming FDIU on a high resolution machine, identifying location of placenta, fetal position (which can help the Ob/Gyns plan delivery), identifying gross features such as oligohydramnios/polyhydramnios/skeletal or any other anomalies in the fetus/placenta that may not be identified at bedside ultrasound, as this can help guide further investigations. It may also help identify other causes, such as IUGR. The thought of an autopsy can be very distressing to parents, so not all parents are willing to go through the autopsy, hence maximizing info through ultrasound may be helpful for future management.
There have a rare number of instances (particularly in cases where imaging was difficult eg. obesity, or where TV scanning was not performed), where fetal heart motion was missed or vice versa. Clinicians sending these referrals may want to eliminate any trace of doubt and share the burden of responsibility. Additionally, it is often requested by the patient and their partner to also be in no doubt about the findings.
As discussed in the below article point of care ultrasound 'should not be considered a substitute for formal diagnostic ultrasound'. Point of care ultrasound in obstetrics: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ajum.12133
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Thank you for your question.
There are numerous useful resources available online:
https://onlinelibrary.wiley.com/doi/full/10.1002/jum.16129
We do not currently have a protocol for endometriosis, however some practices use a checklist, which may include looking for endometriosis markers on a transvaginal examination, (if clinically indicated) which includes:
Adenomyosis, endometriomas, question mark sign (fixed uterine anteversion and/or retroflexion), site specific tenderness, ovarian mobility, fixed/kissing ovaries(fixed together), fallopian tube distortion, the sliding sign(rectum glides freely over cervix), posterior cul-de-sac obliteration and deep infiltrating endometriosis nodules in anterior and posterior compartments.
The ASA is currently investigating hands-on training options.
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have found these 2 articles that may assist the enquirer in regards to differentiating punctate calciifcations versus colloid ring down artifact. Modern equipment does minimise artifacts in some settings, but my advice would be for us to direct this sonographer to their specific manufacturer in order to modify their specific equipment settings. Hope this helps - Marilyn
https://www.sonographers.org/secureassets/872673aa-102e-ee11-9122-0050568796d8/kjr-24-22-thyroid.pdf
Disclaimer: by using this service you recognise that the information provided is general in nature; it does not constitute professional advice. Any views expressed are those of individual(s) and may not reflect ASA’s views. The ASA does not endorse any product or service identified. You use any information provided at your sole risk and the ASA is not responsible for any errors or for any consequences arising from that use.
Thank you for your question,
Peripherally inserted venous catheter (PIVC) are being performed by sonographers in both the public and private sectors to our knowledge. It appears that certification is currently obtained primarily through the institution in which the sonographer is working, however there are also a select range of POCUS courses specific to PIVC insertion available.
Each institution will vary in its training and certification process; however, the majority will involve an initial theory and practical component (with supervision by a trained medical officer, trained health professional or nurse educator) with ongoing maintenance of skill and infection control.
The ASA have produced an online learning module on ultrasound guided IV cannulation. We recommend completing this module as it will provide you with further information. I've attempted to provide a link below for you. Otherwise you will find it in the Online learning modules in the CPD area.
https://www.sonographers.org/cpds/asa-advance---US_guided_IV_Cannulation
Thanks,
Vascular SIG