Frequently Asked Questions (2023)

Why choose single patient gel packets instead of bottled ultrasound gel?

• To bolster your facility’s infection control regimen:Bottled gel is often exposed to multiple patients and staff members, potentially leading to cross-contamination and microbial growth.Clear Image Singles® Gel, in single patient doses, can help reduce the risk of cross-contamination.
• As an alternative to refilling gel bottles:The practice of refilling partially emptied gel bottles may result in mixing new gel with gel that had been exposed to pathogens. Single patient packets are ready to use and require no refilling.
• For convenience:With two pre-measured sizes of single patient packets, Clear Image Singles Gel allows the clinical to dispense the preferred amount of gel with minimal effort or waste. The dispensing spout allows the flow of gel to be controlled — from a dab to a glob — depending on the ultrasound application and the preference of the user.
• For accountability:With single patient packets it’s easier to keep track of gel expenses per patient or per procedure.

Why doesn’t your ultrasound gel contain dye?

Some manufacturers provide ultrasound gel that has been dyed a color, such as blue or green. The gels manufactured by NEXT Medical Products are clear, colorless and non-staining. We believe a dye-free gel helps reduce the potential for skin irritation in sonographers and the patient population who are sensitive to dyes. For the same reasons we do not add perfumes.

Why does ultrasound gel feel cold on the skin?

One of the comments you might hear from someone who has undergone an ultrasound procedure is that the gel feels cold on their skin. Ask an expectant mother about her experience with ultrasound gel and you will often hear that its coldness caused her to flinch.

Ultrasound gel is a water-based product and, over time, water acclimates to the temperature of its ambient environment. An average thermostat setting for an air-conditioned room is 78°F (26°C).¹ If ultrasound gel is stored and used in a place that is air-conditioned, the gel’s temperature will become about the same as the room. Since average human body temperature is 98.6°F (37°C), the gel, in comparison, will feel much cooler to most people.

In addition, ultrasound gel that has been kept in a cool environment will take some time to lose that coolness. Water has a very high specific heat capacity, meaning that a defined amount of energy is required just to raise the temperature by one degree.²

Many practitioners warm ultrasound gel for the comfort of their patients. Typically gel warmers bring gel to average body temperature so the patient does not experience the feeling of cold on their skin. The practice of warming gel, however, is not recommended on a regular basis and shouldn’t be extended over long periods of time due to infection control concerns.³ NEXT Medical offers a Gel Warmer that can accommodate single gel packets or bottled gel.

1 Energy.Gov, Thermostats. U.S. Department of Energy, Washington, DC., June 2012.http://energy.gov/energysaver/articles/thermostats

2 Freeman, Shanna. How Water Works. HowStuffWorks, Inc., 2013.http://science.howstuffworks.com/environmental/earth/geophysics/h2o7.htm

3 CHICA-CANADA Position Statement, Medical Gels. March 2005.http://www.chica.org/pdf/medgels.pdf

Can I use an ultrasound gel substitute?

A quick search on Google will uncover a host of articles and blog posts about common household items that can serve as a substitute for ultrasound scanning gel. Hand sanitizer, baby oil, hand lotion and vegetable oil are some of the frequently mentioned alternatives, particularly for home fetal monitoring. While these items may be handy when nothing else is available, a high quality ultrasound scanning gel remains the best protocol for diagnostic and therapeutic ultrasound procedures.

Ultrasound gel is a couplant that plays an important role in the transmission of ultrasound between the transducer and the skin. It helps to maintain secure contact and prevent air pockets. For maximum acoustic transmission, the couplant must have an acoustic impedance between that of the skin and the face of the transducer. High quality ultrasound gels are manufactured so the sound velocity of the gel is as close as possible to the sound velocity of the skin. This helps avoid refraction in the image.

The use of vegetable oil, mineral oil, or oil-based products, in place of ultrasound scanning gel, can cause damage to, or discoloring of, the transducer. In fact, many warranties provided by manufacturers of ultrasound equipment specifically mention oil-based products as potentially damaging to the transducer. Items with added fragrances as well as lotions with emollients are also cautioned against. Replacing a transducer that became unusable from a gel substitute is an expensive and inconvenient undertaking. New transducers can cost in the $2,000-$15,000 range. In fact, even refurbished transducers can cost in the thousands of dollars.

Another reason household items aren’t practical in place of ultrasound gel is the lack of control when applying the gel-substitute on a patient in a clinical setting. Very runny products, such as baby or mineral oil, will pour out onto the patient and not stay in place. A high viscosity gel, such as Clear Image Singles® Gel, can be applied on specific areas of the body, or even directly on the transducer if that was preferable for the procedure, without running.

What viscosity ultrasound gel should I use?

Viscosity is defined as a measurement of a fluid’s resistance to flow. (The Physics Hypertextbook, Glenn Elert, 1998-2013 http://physics.info/viscosity/). Because ultrasound technology spans a variety of applications, scanning gels are offered in several viscosity options. Gels may be labeled as high, medium, low or light (LITE) viscosity.

In clinical use, the choice of gel viscosity tends to be a matter of user preference. High viscosity gel is used for most ultrasound scanning applications, especially for procedures requiring a thicker, more viscous gel that stays in place. When applying gel directly on a transducer or on an angled part of the body, a high viscosity gel is typically desired. A medium or lower viscosity gel is considered thinner or more “runny” than a high viscosity gel. It offers less resistance as the transducer is moved over the gel during a procedure. Sonographers frequently prefer lower viscosity gel for OB/GYN applications to avoid the “snowplow effect” that occurs with a higher viscosity gel over large surface areas.

We are unaware of any published standards designating gel viscosities for specific ultrasound procedures, or established recommendations for gel manufacturers regarding the differences in the measurement of viscosity between a high versus a medium or low viscosity gel. NEXT Medical manufactures both High and Medium (LITE) viscosity gels. Our medium viscosity gel is 40% less viscous than our high viscosity gel. Other manufacturers may have a higher or lower percentage difference in viscosity between their gel options.

Keep in mind that viscosity varies with temperature. If your protocol includes warming ultrasound gel in a gel warmer prior to use, the gel may not be as viscous as gel left at room temperature. In addition, gel may become less viscous as it remains on a patient and is subjected to body temperature and salt contained in perspiration.

If you are unsure what viscosity ultrasound gel is best for your application, we recommend that you obtain samples of both a high and a medium viscosity gel to try. NEXT Medical Products is happy to comply with sample requests.

What is the impact of air bubbles in ultrasound gel?

During a diagnostic ultrasound procedure, the presence of air in the path of sound waves is undesirable. Air acts as a sound barrier resulting in poorer resolution of the image.¹ When air pockets are present during an ultrasound procedure, sound waves can be blocked from passing into the body.² Eliminating air between the transducer and the patient’s skin allows for better imaging.³

Ultrasound transmission gel is the medium through which the transducer sends sound waves and receives back the echoing waves. The gel helps make secure contact between the transducer and the patient’s body, preventing pockets of air and increasing acoustic transmission. It is advantageous for a clinician to choose an ultrasound gel with as few air bubbles as possible to allow for the best possible imaging results. If sound waves are not able to pass properly from, or back to, the transducer, then clouding, degradation or distortion may occur, affecting the quality of the image and potentially affecting the patient’s diagnosis.

During extracorporeal shock wave lithotripsy (ESWL) procedures, the impact of air bubbles is also significant. In one study, the effectiveness of a lithotripsy treatment was greatly improved by eliminating bubbles from the coupling media.⁴ In another study, the technique used to apply the gel was investigated. This study concluded that lithotripsy results could be improved by applying gel in such a manner as to avoid introducing bubbles during the application of the gel.⁵

For diagnostic ultrasound and lithotripsy procedures, the selection of a quality gel, with minimal air bubbles, is an important part of the imaging process. NEXT Medical utilizes a proprietary manufacturing method to minimize the presence of air bubbles in our gel products. Furthermore, sonographers who utilize single patient packets, such as Clear Image Singles® Gel, can help reduce the introduction of air bubbles caused by repetitive squeezing and shaking down of gel bottles.

References:
1 Stern, Beverly. “The Basic Concepts of Diagnostic Ultrasound 1.” Yale-New Haven Teachers Institute. Curriculum Unit 83.07.05. 2013. http://www.yale.edu/ynhti/curriculum/units/1983/7/83.07.05.x.html Web.
2 “General Ultrasound Imaging, How is the procedure performed?” Radiological Society of North America, Inc. (RSNA). July 2, 2012. < http://www.radiologyinfo.org/en/info.cfm?pg=genus#part_six&gt; Web.
3 Schreiner, Nicholas. “The Science of Ultrasound Within the Body.” The Board of Trustees at the University of Illinois, College of Engineering. December 15, 2010. <https://wiki.engr.illinois.edu/display/BIOE414/The+Science+of+Ultrasound… Web.
4 Shah TK, Jain A. “Effect of Air Bubbles in the Coupling Medium on Efficacy of Extracorporeal Shock Wave Lithotripsy.” European Urology. 2007 Jun;51(6):1680-6; discussion 1686-7. Epub 2006 Nov 10. http://www.europeanurology.com/article/S0302-2838(06)01349-2/abstract Web.
5 Neucks JS, Pishchalnikov YA, Zancanaro AJ, VonDerHaar JN, Williams JC Jr, McAteer JA. “Improved Acoustic Coupling for Shock Wave Lithotripsy.” Urological Research. February 2008, Volume 36, Issue 1, pp 61-66. http://link.springer.com/article/10.1007%2Fs00240-007-0128-y# Web.

Why doesn’t the end of the Clear Image Singles® Gel packet open completely?

When I tear off the end of the Clear Image Singles® Gel packet, why doesn’t the end open completely? Why is this packet different than others?

The Clear Image Singles® Gel packet is designed to form a “spout” when the perforated end is torn off. This “dispensing spout” allows the sonographer to dispense all the gel from the packet in a deliberate, controlled manner and apply it more precisely in a desired location, such as a dab of gel on a transducer. The built-in “spout” not only helps control the flow of the gel, but it also exposes less gel along the edge of the packet, making the Clear Image Singles Gel packet much cleaner and neater than packets that have a wide-open end.

The Clear Image Singles® Gel packet is made from a specially selected polyester-based material that is puncture-resistant and provides barriers to oxygen and moisture to help preserve the viscosity and integrity of the gel. As compared to rectangular-shaped, aluminum foil-type packs, the elongated shape of the Clear Image Singles Gel packet comfortably fits into the ultrasound technician’s hand. One side is deliberately smooth and rounded so the technician’s fingers don’t come in contact with an edge while removing the gel. Competitive packets have a pointy, sealed edge all the way around the pack’s perimeter. The smoothness of our material and the slim shape of the packet aid the sonographer in easily removing Clear Image Singles Gel with minimal effort. The user can choose from two sizes of gel packets: a 30 mL packet that contains 1/3 more gel than competitive 20 gram packs and a 15 mL packet for procedures requiring less gel.

What are some helpful ultrasound resources?

●For ultrasound professionals:

ACR – American College of Radiology
AIUM – American Institute of Ultrasound in Medicine
AuntMinnie.com
RSNA – Radiological Society of North America
SDMS – Society of Diagnostic Medical Sonography
Ultrasound First
World Federation for Ultrasound in Medicine and Biology

●For veterinary:
American College of Veterinary Radiology

●For patients:
RadiologyInfo.org

_{Links provided are not to be construed as endorsements.}

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