Page 44 - Journal of Special Operations Medicine - Spring 2017

A Novel Ultrasound Transmission Gel

for Resource-Constrained Environments

Jonathan Monti, DSc, PA-C, RDMS

ABSTRACT
Ultrasound represents an ideal diagnostic adjunct for Previous studies have examined the feasibility of trans-
medical personnel operating in austere environments, mission gel alternatives that may be used in lieu of
because of its increasing portability and expanding standard ultrasound gel. Olive oil was found to be a
number of point-of-care applications. However, these suitable transmission medium compared with standard
machines cannot be used without a transmission me- gel when evaluating sonographic image quality. Olive
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dium that allows for propagation of ultrasound waves oil, along with several other alternatives, including hand
from transducer to patient. This article describes a novel lotion, liquid detergent, baby shampoo, and hairstyling
ultrasound gel alternative that may be better suited for gel, when evaluated for image quality, were found to
resource-constrained environments than standard ultra- be comparatively inferior to standard ultrasound gel,
sound gel, without compromising image quality. with only hand sanitizer producing similar-quality sono-
graphic images. Each of these alternatives comes in gel
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Keywords: ultrasound; austere; ultrasound gel; military; or liquid form, thereby increasing their relative bulk and
POCUS weight, which must be considered when load planning
before operating in resource-constrained environments.
A mixture of cornstarch and water has been suggested
as an ideal alternative for resource-constrained environ-
Introduction
ments; however, this mixture requires boiling of water,
Recent technological advances have led to the devel- which may not be feasible in an austere environment. 10
opment of highly portable ultrasound machines that
have proved to be invaluable in environments such as Novel Gel Alternative
mountainous terrain, space, and military/operational
settings. In addition to its portability, there are an in- Glucomannan powder is a water-soluble, bulk-forming
1,2
creasing number of applications for ultrasound that are fiber derived from Konjac root. It is available as a fi-
being used easily and safely by many healthcare provid- ber supplement in many health food stores and online
ers at the point of care, including Special Forces Medi- (Figure 1). Approximately 1 tsp of glucomannan pow-
cal Sergeants and the Special Operations Forces medical der, when mixed with 0.25L (8 oz) of water, the amount
providers who support them. 3–7 found in typical commercial ultrasound transmission
gel bottles, will provide a gel consistency very similar to
When using ultrasound, a transmission medium be- that of standard ultrasound transmission gel (Figure 2).
tween the transducer and patient allows for propaga-
tion of sound waves from the transducer into the body The quality of images can limit point-of care sonogra-
to the target anatomic structure. Without such a me- phers’ ability to adequately interpret the findings, thus
dium, ultrasound image acquisition becomes impossible affecting medical decision-making. Therefore, it is im-
and expensive machines are rendered useless. Standard perative that any proposed gel alternative not signifi-
transmission gel can often be carried into austere envi- cantly degrade image quality. Figure 3 is an ultrasound
ronments but usually in limited supply because of its image of the right upper quadrant of a patient’s abdo-
relative bulk. Additionally, upon arrival in resource- men obtained with standard transmission gel (Figure
constrained environments, standard commercial gel 3A) and with glucomannan-based gel (Figure 3B), using
may be unobtainable due to a lack of established supply a low-frequency curvilinear transducer. Figure 4 is an
chains and may be unlikely to be procured locally in ultrasound image of a patient’s common femoral artery
such environments. and vein obtained with standard transmission gel ( Figure

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