<p begin="00:00:00.000" end="00:00:02.167">(silence)</p>

<p begin="00:00:02.788" end="00:00:05.595" style="s2">- If my wife or one of my children</p>
<p begin="00:00:05.595" end="00:00:09.516" style="s2">needed a central line, I<br />would ask two questions.</p>
<p begin="00:00:09.516" end="00:00:11.620" style="s2">I would need to know the experience</p>
<p begin="00:00:11.620" end="00:00:14.177" style="s2">of the individual who's placing the line</p>
<p begin="00:00:14.177" end="00:00:17.513" style="s2">and whether or not he or<br />she is using ultrasound.</p>
<p begin="00:00:17.513" end="00:00:19.625" style="s2">And if they're not using ultrasound,</p>
<p begin="00:00:19.625" end="00:00:21.958" style="s2">I would find another doctor.</p>
<p begin="00:00:22.939" end="00:00:25.522" style="s2">(lively music)</p>
<p begin="00:00:41.010" end="00:00:43.991" style="s2">- [Man] When I came to<br />Houston and Memorial Hermann,</p>
<p begin="00:00:43.991" end="00:00:45.277" style="s2">I became aware that ultrasound</p>
<p begin="00:00:45.277" end="00:00:48.228" style="s2">wasn't being used for<br />central line insertion.</p>
<p begin="00:00:48.228" end="00:00:49.821" style="s2">Either in our hospitals</p>
<p begin="00:00:49.821" end="00:00:53.281" style="s2">or in the general medical community.</p>
<p begin="00:00:53.281" end="00:00:55.134" style="s2">- It is just like driving blindly</p>
<p begin="00:00:55.134" end="00:00:58.462" style="s2">on the road versus driving<br />with your total vision, right?</p>
<p begin="00:00:58.462" end="00:01:00.722" style="s2">It gives you total confidence</p>
<p begin="00:01:00.722" end="00:01:04.333" style="s2">and certainty about what you're doing.</p>
<p begin="00:01:04.333" end="00:01:05.598" style="s2">And what is happening with the patient</p>
<p begin="00:01:05.598" end="00:01:07.521" style="s2">which is the most important thing.</p>
<p begin="00:01:07.521" end="00:01:09.455" style="s2">- I presented the results</p>
<p begin="00:01:09.455" end="00:01:11.670" style="s2">of the use of ultrasound at Cedar Sinai</p>
<p begin="00:01:11.670" end="00:01:13.577" style="s2">and also results in the literature</p>
<p begin="00:01:13.577" end="00:01:15.320" style="s2">from around the world.</p>
<p begin="00:01:15.320" end="00:01:17.162" style="s2">Showing that the injuries</p>
<p begin="00:01:17.162" end="00:01:19.957" style="s2">from central line insertion can be reduced</p>
<p begin="00:01:19.957" end="00:01:22.941" style="s2">if not eliminated with<br />ultrasound guidance.</p>
<p begin="00:01:22.941" end="00:01:25.744" style="s2">- You cannot achieve the kind of numbers</p>
<p begin="00:01:25.744" end="00:01:27.577" style="s2">that have been achieved nation wide</p>
<p begin="00:01:27.577" end="00:01:29.271" style="s2">without using ultrasound.</p>
<p begin="00:01:29.271" end="00:01:30.580" style="s2">But in our way we say</p>
<p begin="00:01:30.580" end="00:01:33.177" style="s2">central lines should not<br />cause pneumothoraces.</p>
<p begin="00:01:33.177" end="00:01:36.806" style="s2">It should be a rarity rather<br />than the acceptability.</p>
<p begin="00:01:36.806" end="00:01:38.929" style="s2">And that's where we're<br />doing in this hospital.</p>
<p begin="00:01:38.929" end="00:01:41.135" style="s2">Trying to show that you<br />can do a lot of lines</p>
<p begin="00:01:41.135" end="00:01:43.260" style="s2">without doing pneumothorax.</p>
<p begin="00:01:43.260" end="00:01:45.435" style="s2">And we have been able to do so so far.</p>
<p begin="00:01:45.435" end="00:01:48.750" style="s2">- In fact, for two of our hospitals,</p>
<p begin="00:01:48.750" end="00:01:52.142" style="s2">they've reported over a year's worth</p>
<p begin="00:01:52.142" end="00:01:55.024" style="s2">of practice in the hospital</p>
<p begin="00:01:55.024" end="00:01:59.191" style="s2">without the occurrence of a<br />single iatrogenic pneumothorax.</p>
<p begin="00:02:00.444" end="00:02:02.559" style="s2">- These are considered<br />never events certainly</p>
<p begin="00:02:02.559" end="00:02:06.815" style="s2">by Medicare and probably<br />will be never events</p>
<p begin="00:02:06.815" end="00:02:08.710" style="s2">by insurance companies.</p>
<p begin="00:02:08.710" end="00:02:10.593" style="s2">And probably will be never events</p>
<p begin="00:02:10.593" end="00:02:12.178" style="s2">from the legal system.</p>
<p begin="00:02:12.178" end="00:02:14.056" style="s2">So that's really three good reasons</p>
<p begin="00:02:14.056" end="00:02:16.219" style="s2">other than intellectually wanting</p>
<p begin="00:02:16.219" end="00:02:18.196" style="s2">to do the right thing.</p>
<p begin="00:02:18.196" end="00:02:20.839" style="s2">- We've actually created a new award</p>
<p begin="00:02:20.839" end="00:02:24.498" style="s2">for hospitals that are achieving zero</p>
<p begin="00:02:24.498" end="00:02:28.081" style="s2">iatrogenic pneumothoraces<br />for a whole year.</p>
<p begin="00:02:29.708" end="00:02:32.266" style="s2">We're goin' for zero.</p>
<p begin="00:02:32.266" end="00:02:33.340" style="s2">This amazing?</p>
<p begin="00:02:33.340" end="00:02:36.000" style="s2">And actually, I didn't even mention it</p>
<p begin="00:02:36.000" end="00:02:38.561" style="s2">but we, our emergency departments.</p>
<p begin="00:02:38.561" end="00:02:42.440" style="s2">We have nine of 'em,<br />busy, we saw over 400,000</p>
<p begin="00:02:42.440" end="00:02:43.746" style="s2">visits last year.</p>
<p begin="00:02:43.746" end="00:02:45.579" style="s2">They placed a lot of central lines.</p>
<p begin="00:02:45.579" end="00:02:49.075" style="s2">They use ultrasound and it is amazing</p>
<p begin="00:02:49.075" end="00:02:52.158" style="s2">but we had no iatrogenic pnuumothorax</p>
<p begin="00:02:53.096" end="00:02:55.179" style="s2">for the whole year.</p>
<p begin="00:02:55.179" end="00:02:57.210" style="s2">(lively music)</p>
<p begin="00:02:57.210" end="00:02:58.517" style="s2">We're talkin' about emergencies.</p>
<p begin="00:02:58.517" end="00:03:00.255" style="s2">We're talkin' about level one trauma.</p>
<p begin="00:03:00.255" end="00:03:02.052" style="s2">I mean this is pretty amazing.</p>
<p begin="00:03:02.052" end="00:03:04.635" style="s2">(lively music)</p>
<p begin="00:03:06.715" end="00:03:08.490" style="s2">- A few weeks back I have a patient</p>
<p begin="00:03:08.490" end="00:03:11.573" style="s2">in the ICU, almost 350 or 380 pounds.</p>
<p begin="00:03:14.641" end="00:03:16.476" style="s2">Blood pressure was in 60s.</p>
<p begin="00:03:16.476" end="00:03:19.125" style="s2">Neck was barely visible.</p>
<p begin="00:03:19.125" end="00:03:20.944" style="s2">Groin we can not access.</p>
<p begin="00:03:20.944" end="00:03:23.481" style="s2">And we got the ultrasound.</p>
<p begin="00:03:23.481" end="00:03:25.304" style="s2">Was able to look at thigh jay</p>
<p begin="00:03:25.304" end="00:03:27.115" style="s2">and we put the line in.</p>
<p begin="00:03:27.115" end="00:03:28.954" style="s2">And that was the best thing</p>
<p begin="00:03:28.954" end="00:03:32.148" style="s2">because it was made out of night almost</p>
<p begin="00:03:32.148" end="00:03:34.051" style="s2">and we need a line.</p>
<p begin="00:03:34.051" end="00:03:35.218" style="s2">And we got it.</p>
<p begin="00:03:36.222" end="00:03:37.341" style="s2">Patient did very well</p>
<p begin="00:03:37.341" end="00:03:39.425" style="s2">and eventually she got out of ICU.</p>

<p begin="00:00:00.543" end="00:00:03.626" style="s2">(light techno music)</p>
<p begin="00:00:08.868" end="00:00:12.118" style="s2">- [Voiceover] Welcome to the help video</p>
<p begin="00:00:14.251" end="00:00:15.377" style="s2">In this video,</p>
<p begin="00:00:15.377" end="00:00:18.190" style="s2">we will walk you though<br />cleaning and disinfecting</p>
<p begin="00:00:18.190" end="00:00:20.773" style="s2">both the system and transducer.</p>
<p begin="00:00:21.658" end="00:00:23.970" style="s2">Let's start with the system.</p>
<p begin="00:00:23.970" end="00:00:25.278" style="s2">Before cleaning,</p>
<p begin="00:00:25.278" end="00:00:28.291" style="s2">you want to make sure to<br />disconnect the transducer</p>
<p begin="00:00:28.291" end="00:00:30.291" style="s2">and turn off the system.</p>
<p begin="00:00:31.272" end="00:00:33.980" style="s2">Clean the exterior surfaces using either</p>
<p begin="00:00:33.980" end="00:00:37.046" style="s2">a soft cloth dampened with a disinfectant,</p>
<p begin="00:00:37.046" end="00:00:38.662" style="s2">or a pre-moistened wipe</p>
<p begin="00:00:38.662" end="00:00:40.916" style="s2">from the list of approved disinfectants</p>
<p begin="00:00:40.916" end="00:00:44.926" style="s2">to remove any particulate<br />matter or body fluids.</p>
<p begin="00:00:44.926" end="00:00:47.518" style="s2">Be sure to apply the solution to the cloth</p>
<p begin="00:00:47.518" end="00:00:50.438" style="s2">rather than applying it<br />directly to the surface</p>
<p begin="00:00:50.438" end="00:00:51.851" style="s2">making sure the solution</p>
<p begin="00:00:51.851" end="00:00:55.507" style="s2">does not get into the connector ports.</p>
<p begin="00:00:55.507" end="00:00:57.675" style="s2">Allow the system to air dry</p>
<p begin="00:00:57.675" end="00:01:01.697" style="s2">or dry it off with a soft, clean cloth.</p>
<p begin="00:01:01.697" end="00:01:05.670" style="s2">Next let's clean and<br />disinfect the transducer.</p>
<p begin="00:01:05.670" end="00:01:09.685" style="s2">Clean the transducer surface<br />using a damp, soft cloth</p>
<p begin="00:01:09.685" end="00:01:14.493" style="s2">to remove any gel, particulate<br />matter, and body fluids.</p>
<p begin="00:01:14.493" end="00:01:17.343" style="s2">Starting from the transducer's scan head,</p>
<p begin="00:01:17.343" end="00:01:20.926" style="s2">wipe in a downward<br />motion towards the cord.</p>
<p begin="00:01:23.032" end="00:01:25.680" style="s2">Once the transducer body is clean,</p>
<p begin="00:01:25.680" end="00:01:28.799" style="s2">use a thin instrument, such as a swab,</p>
<p begin="00:01:28.799" end="00:01:31.365" style="s2">to push the soft damp cleaning cloth</p>
<p begin="00:01:31.365" end="00:01:34.032" style="s2">back and forth through the slot.</p>
<p begin="00:01:40.365" end="00:01:43.596" style="s2">Then rinse or wipe the<br />transducer with water</p>
<p begin="00:01:43.596" end="00:01:46.263" style="s2">to remove the soap or detergent.</p>
<p begin="00:01:48.199" end="00:01:52.594" style="s2">To disinfect the transducer<br />using an approved disinfectant,</p>
<p begin="00:01:52.594" end="00:01:56.775" style="s2">disinfect the slot first<br />and then the transducer.</p>
<p begin="00:01:56.775" end="00:01:59.630" style="s2">If you use the immersion<br />method of disinfecting,</p>
<p begin="00:01:59.630" end="00:02:00.838" style="s2">be sure to follow</p>
<p begin="00:02:00.838" end="00:02:03.631" style="s2">the disinfectant<br />manufacturer's instructions</p>
<p begin="00:02:03.631" end="00:02:05.513" style="s2">and only immerse the transducer</p>
<p begin="00:02:05.513" end="00:02:08.430" style="s2">up to 12 inches from the connector.</p>
<p begin="00:02:09.281" end="00:02:11.669" style="s2">After cleaning and disinfecting,</p>
<p begin="00:02:11.669" end="00:02:16.129" style="s2">check the transducer and<br />cable for any visible damage.</p>
<p begin="00:02:16.129" end="00:02:18.177" style="s2">If you do see any damage,</p>
<p begin="00:02:18.177" end="00:02:22.344" style="s2">discontinue use and contact<br />Fujifilm Sonosite for service.</p>
<p begin="00:02:24.327" end="00:02:25.866" style="s2">For more detailed information</p>
<p begin="00:02:25.866" end="00:02:28.661" style="s2">on cleaning and disinfecting iViz,</p>
<p begin="00:02:28.661" end="00:02:31.661" style="s2">refer to the iViz system user guide.</p>

<p begin="00:00:00.569" end="00:00:04.069" style="s2">(mellow electronic music)</p>
<p begin="00:00:08.981" end="00:00:12.601" style="s2">- [Voiceover] Welcome to the<br />help video Taking Measurements.</p>
<p begin="00:00:12.601" end="00:00:15.374" style="s2">In this video, we will<br />walk you through how to</p>
<p begin="00:00:15.374" end="00:00:20.082" style="s2">take a general measurement with<br />your iViz Ultrasound System.</p>
<p begin="00:00:20.082" end="00:00:22.832" style="s2">While scanning, freeze the image.</p>
<p begin="00:00:25.847" end="00:00:28.723" style="s2">Tap Measurements, and choose either</p>
<p begin="00:00:28.723" end="00:00:31.640" style="s2">the Distance or Volume measurement.</p>
<p begin="00:00:33.073" end="00:00:37.372" style="s2">Drag the active caliper to<br />the start of your measurement.</p>
<p begin="00:00:37.372" end="00:00:41.321" style="s2">Lift your finger to<br />activate the second caliper.</p>
<p begin="00:00:41.321" end="00:00:45.796" style="s2">Slide and place that<br />caliper at your end point.</p>
<p begin="00:00:45.796" end="00:00:50.526" style="s2">The measurement appears on the<br />top left side of the screen.</p>
<p begin="00:00:50.526" end="00:00:54.443" style="s2">To re-position a caliper,<br />just touch and slide.</p>
<p begin="00:00:55.754" end="00:00:59.497" style="s2">To add an additional caliper,<br />tap the measurement type</p>
<p begin="00:00:59.497" end="00:01:02.747" style="s2">and place those calipers on the screen.</p>
<p begin="00:01:04.308" end="00:01:08.494" style="s2">To delete a caliper, select<br />the caliper you want to delete</p>
<p begin="00:01:08.494" end="00:01:10.411" style="s2">and then tap the red X.</p>
<p begin="00:01:13.756" end="00:01:15.387" style="s2">A volume measurement requires</p>
<p begin="00:01:15.387" end="00:01:18.371" style="s2">that you take three measurements,</p>
<p begin="00:01:18.371" end="00:01:21.538" style="s2">the length, the width, and the height.</p>
<p begin="00:01:22.772" end="00:01:25.338" style="s2">Simply tap the corresponding measurement</p>
<p begin="00:01:25.338" end="00:01:28.505" style="s2">and place your calipers on the screen.</p>
<p begin="00:01:31.828" end="00:01:34.611" style="s2">Once all three measurements are completed,</p>
<p begin="00:01:34.611" end="00:01:36.206" style="s2">your volume measurement will appear</p>
<p begin="00:01:36.206" end="00:01:39.874" style="s2">on the upper left side of the screen.</p>
<p begin="00:01:39.874" end="00:01:43.937" style="s2">Be aware that general<br />measurements appear onscreen only,</p>
<p begin="00:01:43.937" end="00:01:46.909" style="s2">and are not in a specific report page.</p>
<p begin="00:01:46.909" end="00:01:49.805" style="s2">Because of this, we recommend<br />that you save the image</p>
<p begin="00:01:49.805" end="00:01:53.740" style="s2">with the measurements<br />before ending the study.</p>
<p begin="00:01:53.740" end="00:01:56.810" style="s2">For more information about<br />measurements and calculations,</p>
<p begin="00:01:56.810" end="00:01:59.227" style="s2">refer to the iViz user guide.</p>

<p begin="00:00:08.737" end="00:00:12.602" style="s2">- [Voiceover] Welcome to the<br />help video Annotating an Image.</p>
<p begin="00:00:12.602" end="00:00:15.128" style="s2">In this video, we will walk you through</p>
<p begin="00:00:15.128" end="00:00:17.874" style="s2">how to create a custom annotation label</p>
<p begin="00:00:17.874" end="00:00:19.828" style="s2">and then annotate an image</p>
<p begin="00:00:19.828" end="00:00:23.300" style="s2">using your iViz ultrasound system.</p>
<p begin="00:00:23.300" end="00:00:27.910" style="s2">To create custom labels,<br />tap the iViz settings icon</p>
<p begin="00:00:27.910" end="00:00:29.160" style="s2">and tap labels.</p>
<p begin="00:00:30.462" end="00:00:32.862" style="s2">Select an exam type.</p>
<p begin="00:00:32.862" end="00:00:36.592" style="s2">There you will find a list<br />of the exams default labels.</p>
<p begin="00:00:36.592" end="00:00:41.108" style="s2">From here, you can also add<br />up to ten custom labels.</p>
<p begin="00:00:41.108" end="00:00:43.129" style="s2">To create a custom label,</p>
<p begin="00:00:43.129" end="00:00:46.177" style="s2">type the label name in the Add field.</p>
<p begin="00:00:46.177" end="00:00:48.967" style="s2">If you want to create more than one label,</p>
<p begin="00:00:48.967" end="00:00:51.951" style="s2">separate the label names with a comma,</p>
<p begin="00:00:51.951" end="00:00:53.034" style="s2">then tap Add.</p>
<p begin="00:00:54.539" end="00:00:59.108" style="s2">Note that you cannot add<br />spaces to the label names.</p>
<p begin="00:00:59.108" end="00:01:02.626" style="s2">You can also create custom<br />labels while annotating</p>
<p begin="00:01:02.626" end="00:01:06.767" style="s2">and they will be added to the<br />exam type you're currently in.</p>
<p begin="00:01:06.767" end="00:01:08.946" style="s2">To annotate on the current image,</p>
<p begin="00:01:08.946" end="00:01:12.029" style="s2">freeze the image and tap Text Labels.</p>
<p begin="00:01:14.261" end="00:01:17.729" style="s2">Select a label from the<br />list and drag the label</p>
<p begin="00:01:17.729" end="00:01:21.018" style="s2">to where you want to<br />place it on the screen.</p>
<p begin="00:01:21.018" end="00:01:23.851" style="s2">To add an arrow, tap + Arrow.</p>
<p begin="00:01:25.205" end="00:01:28.062" style="s2">If you want, rotate the arrow by grabbing</p>
<p begin="00:01:28.062" end="00:01:31.645" style="s2">the blue orientation<br />arrow and rotating it.</p>
<p begin="00:01:32.575" end="00:01:36.514" style="s2">Then place the arrow where you want it.</p>
<p begin="00:01:36.514" end="00:01:38.436" style="s2">To create a custom label,</p>
<p begin="00:01:38.436" end="00:01:42.103" style="s2">type the label name in<br />the enter text field.</p>
<p begin="00:01:50.584" end="00:01:52.917" style="s2">If you want to delete a custom label,</p>
<p begin="00:01:52.917" end="00:01:55.975" style="s2">you must go back to the<br />label setting screen</p>
<p begin="00:01:55.975" end="00:01:57.642" style="s2">and delete it there.</p>
<p begin="00:02:12.223" end="00:02:16.354" style="s2">To annotate a saved image,<br />slide the tool drawer up</p>
<p begin="00:02:16.354" end="00:02:18.187" style="s2">to access Text Labels.</p>
<p begin="00:02:19.054" end="00:02:21.909" style="s2">For more information<br />about annotating images,</p>
<p begin="00:02:21.909" end="00:02:24.409" style="s2">refer to the iViz User Guide.</p>