Please read this article on Washington Post. This happened in the state of New Jersey, what a coincidence! Luckily we do not use that brand in our lab. seizes contaminated ultrasound gel

By Dina ElBoghdady, Wednesday, April 18, 7:17 PM
U.S. marshals seized ultrasound gel produced by a New Jersey company after the government found two dangerous strains of bacteria in the product.

The Food and Drug Administration, which announced the seizure Wednesday, did not comment on how widely the gel was distributed. But it warned health-care professionals to immediately stop using the product — “Other-Sonic Generic Ultrasound Transmission” by Pharmaceutical Innovations in Newark.
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The agency discovered the contamination after a hospital reported that 16 of its patients were infected with Pseudomonas aeruginosa following heart valve replacement surgery. In such surgeries, ultrasound probes are inserted into the esophagus to get a clear image of the heart, and the gel helps improve transmission of the sound waves.

The FDA said in a statement that patients exposed to the bacteria on the surface of their skin could develop severe skin inflammation. Invasive biopsy procedures can carry the strain into tissues, causing an abscess or blood poisoning. The microbe also can move from one part of the body to another.

Upon testing samples of the gel, the FDA also found that it contained Klebsiella oxytoca, which often lives in the digestive tract without posing any health risks. But the strain can cause pneumonia and other serious infections if exposed to the lungs and other tissues.

“This ultrasound gel presented serious health risks to patients, particularly vulnerable ones,” Dara A. Corrigan, FDA’s associate commissioner for regulatory affairs, said in a statement. “Therefore, FDA, with the assistance of our state partner, is taking aggressive enforcement action to protect the public health.”

The New Jersey Department of Health and Senior Services held on to the product until U.S. marshals seized it under a court order sought by the FDA.

The New Jersey health agency said that Pharmaceutical Innovations was not licensed by the state.

While ultrasounds are commonly used during pregnancy to provide images of the fetus, it is unclear if any of the product was used for such purposes. But the likelihood of getting an infection from an abdominal ultrasound is remote unless the patient has a cut on her skin, an FDA spokesman said. If the patient had a transvaginal ultrasound, then the risk would be greater.

Ultrasound technology also can be used to look inside the body in a non-invasive way to spot anything from ovarian masses and gallstones to aortic aneurysms in the abdomen.

This is a very interesting video. This could be our future....
Recently, patients have been asking me about the significance of "bear down" and what that exactly does to the exam. A Venous Reflux exam can be tedious if the patient does not know how to properly "bear down". I tell my patients to "bear down" like they are having a bowel movement. Many of them look at me weird and simply say "What does that do"? 

The calf muscle pump is critical in maintaining venous hemodynamics and the purpose of this exam is to know if the calf muscle pump is working effectively. An effective calf muscle pump consists of three things: 1) veins as reservoirs for blood collection 2) the contracting muscles of the legs, and 3) competent valves maintaining unidirectional blood flow. Therefore, when the calf muscle pump is effective, blood moves toward the heart resulting in a decrease in venous pooling, decrease in venous pressure, and an increase in venous return. 

Hopefully my patients know why it is important to "bear down" during the exam. I am craving some dark chocolate I think I might need some energy boost! 
Happy New Year everyone! I want to congratulate Manny Gracia for passing his Boards. Manny is a recent graduate from Chicago and was the blogger for the 2011 SVU Annual Conference in Chicago. He inspired me to create this blog. Best of luck in your future Manny!
I cannot believe it is January already, where does the time go??  Soon, I will start performing renal artery exams in my lab and although they are the toughest, I am still looking forward to it. The renal arteries can be challenging, but that makes it more intriguing for me. Time for some hot coco I am brutally cold! Why does Jersey have to be like Siberia!?
I cannot believe it is December already, I have been in my externship for over 3 months now. A week from now I will be in New Orleans for the SVU Board of Directors Meeting. It will be my first time traveling to the beautiful city of NOLA and I'm very eager to attend the meeting and see everyone again. I have not seen them since June when the Annual Conference in Chicago took place! NOLA is famous for its festivals such as Mardi Gras and of course the Sazerac cocktail that I will be indulging upon arrival! I will be roaming through Bourbon, Magazine, and Frenchmen St. to discover the nightlife NOLA has to offer, perhaps I might need to pack a hangover remedy....tomato juice and tabasco?? BYE JERSEY

Travel season is starting time to get out the suitcases and start packing...

New Orleans here I come!
Wearing gloves is important when performing any type of vascular ultrasound exams. Yesterday evening, I had some sort of blister on my left index finger and it was irritating me. I figured it was a bug bite or something along those lines, I put some corticoid cream which helped relieve the irritation and within an hour it had disappeared.  
I found this interesting article that I wanted to share on why we should wear gloves ALL the time. Wearing gloves is a must when coming in any kind of contact with patients. As vascular sonographers we must be aware of this..
One thing about this profession is you must be aware of your posture, having the proper ergonomics is crucial when performing the different types of studies. Unfortunately, I am only 5 foot 2 and most of my patients will be bigger than me considering I am the size of a walnut. When performing bilateral exams, I tend to use my right hand since I am right-handed. I make sure I adjust the bed properly and I always tell my patients to move more towards me so I avoid from reaching over too far over the patient. This also avoids extreme flexion or deviation of my hand, awkward posture, or discomfort. The last thing I want to develop from my job is back pain or carpel tunnel syndrome. Off to watch Rachel Zoe, my inspiration for new wardrobe. “Style is Personal but Taste Isn’t" - The Rachel Zoe Team

After a month living here, I have discovered some great coffee houses. My favorite is Chez Alice Cafe & Bakery, along with Small World Cafe and The Bent Spoon. I like to enjoy my hot chocolate with my Mac in front of me as I type away. I have come to realized that in coffee shops you will come across some very interesting people. Although my Mac always keeps me occupied I try not to send off "I'm busy" vibes because I enjoy meeting new people that can share an experience that I have yet to encounter. When I stumble upon someone for the very first time, I tend to look at their hands. I believe hands tell all. Observe the fingers of someone's hand perhaps they can tell you something that you may want to know....
Which procedure is better? Both procedures have their benefits and I am proud to announce that in my lab we are going to start performing Radiofrequency Ablation (RFA). If you are not familiar with these two terms they are used for the treatment of varicose veins (bulging veins). They both are noninvasive and catheters are used to get to the abnormal vein in order to close it up. With RFA, there is usually less pain post op and less bruising than with laser ablation. RFA is typically the preferred method because it is generally associated with less discomfort. Both techniques are fairly fast and they are incredible improvements over the traditional vein stripping. With that in mind, if you or anyone you know have varicose veins, you know which treatments are commonly used. Oh the joy of aging :) Is it Friday yet? 

I am still not used to the long hours Monday-Friday, perhaps wearing compression stockings will help. I would like a masseur hopefully my mentor can hire one. As I am observing all kinds of vascular studies, and learning the new equipment that is being used here at the vascular lab, a case that stood out was a patient who was getting a carotid exam. I noticed that their right vertebral artery had a to-and-fro waveform or retrograde flow. When that situation arises you automatically should scan the brachiocephalic or innominate artery to check for stenosis. The diagnosis for this patient is subclavian steal syndrome (SSS). It is narrowing or occlusion of the subclavian artery. Off to watch the Real HouseWives of Beverly Hills...hasta mañana!


    I want to reach out to all students and any individual who is interested in the vascular ultrasound field.  Contributing my opinion and experience as a student I can bring awareness so existing or perspective students can benefit from what I have learned. Having the opportunity to voice my experience as a student may help improve challenges that many students go through while becoming a vascular sonographer. Becoming an expert in my field is my passion.


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