Point-of-care
ultrasound systems play an important role in the treatment of complicated
medical cases at theRoyal Surrey County
Hospital in Guildford, as consultant intensivist and anaesthetist Dr Justin
Kirk-Bayley explained.
The Royal Surrey County Hospital is a 527-bed general
hospital and a specialist tertiary centre for cancer, oral and maxillofacial
surgery and pathology. As a major cancer centre, the hospital treats some very
difficult and complicated patients, and so has a larger than average 28-bed
intensive care unit (ICU). The hospital is also a national leader for enhanced
recovery after surgery, enabling more cancer surgery to be performed as
patients spend less time in the ICU. Point-of-care ultrasound plays an
important role across departments and in a range of procedures, and the
hospital has invested in a number of SonoSite instruments – including M-Turbo®,
Edge®, S-Nerve™ and XPorte® systems – across various
departments.
In recent years, I have taught ultrasound
techniques extensively, and our department is starting to push some frontiers
in terms of the development of ultrasound skills, keeping pace with other key
opinion leaders. It has become clear that a good knowledge of the use of
ultrasound is essential for both anaesthesia and intensive care. In the
intensive care environment, ultrasound guidance is always used for line
placement and the insertion of chest drains, and echocardiography is increasingly
common, particularly since the establishment of FICE (focused intensive care echocardiography)
a couple of years ago. Lung ultrasonography is another application with great
potential; although still a fledgling technique in the UK, it is already
established in some areas of Europe, particularly in France. To help us perform
these more advanced examinations, we have invested in a SonoSite XPorte
point-of-care ultrasound system.
One of the major difficulties in treating intensive
care patients is that they cannot usually be transferred to radiology for an
ultrasound scan. Training ICU staff to perform some of the more routine scans
can help to overcome this issue. We already had a SonoSite Edge in the ICU, and
the radiology department had an X-Porte system. Investing in an X-Porte for the
ICU, complementing our existing system and that in radiology, not only offered us
advanced ultrasound capabilities, it also ensured continuity for attending radiologists,
providing access to familiar equipment of the high quality that they are used
to, and enabling them to make a good assessment of the patient’s condition. For
similar reasons, when the A&E department was looking for a point-of-care
ultrasound system we suggested the X-Porte, giving the critical care outreach
service the same continuity when they are called to attend patient
resuscitation and other difficult cases.
Whenever we purchase new equipment, it is important
that it is as future-proof as possible. With the X-Porte, not only is the hardware
fantastic, but the platform is heavily software-based, and therefore dynamic.
This will allow it to evolve with us, as subsequent enhancements are not
limited by hardware constraints. It is also essential that any downtime is as
short as possible, and the design of the X-Porte allows the central processing
unit to be quickly and easily exchanged should it prove necessary, without the
need to remove the instrument for off-site repair.
We’ve had our X-Porte for a few months now, and it has proved very popular, enthusing my
colleagues and becoming the ‘go-to’ instrument. It is very reliable, and
offers an image quality previously seen only in the hands of an
echocardiographer or a radiologist, with a nice wide viewing angle, allowing us
to perform the more advanced echocardiography needed for FICE. It is simply a
generation ahead. The touch screen user interface, although quite different, is
very intuitive; with smartphones and tablet computers commonplace, most people
using the XPorte are already familiar with – and have expectations of – this
type of interface. The system is very mobile, the height can be quickly and
easily adjusted, and the large screen is fantastic. This allows me to position
the X-Porte so that I have a good view of the screen while scanning, and everybody
else within that bed space can see the image too, which is ideal for training
purposes and makes it easier to explain the procedure to the patient. The learning
modules on the XPorte are interesting too and, in time, I’d like to integrate
them into my teaching.
We have a fantastic relationship with SonoSite, and
that was factored into the tendering process, taking into consideration not
only the capabilities and reliability of the instrument, but also the quality
of service, the warranty, and the level of customer support. We looked at other
systems but, when compared objectively, the X-Porte was leagues ahead. When you
put the whole package together, it just leaves everything else standing.
Source & Image Credit: Sonosite