Ultrasound Preparation

Part of your duties as an Ultrasound Tech will be to relay important information to patients about their upcoming ultrasound test.  Some types of ultrasound require the patient to follow instructions at home before their ultrasound appointment. These instructions ensure a clear and concise ultrasound can be obtained, as well as interpreted by the Physician. Without proper preparation, the test may be compromised. The resulting ultrasound picture could be obscured. If a patient does not perform the needed preparations, their appointment may need to be rescheduled for a future date.

Along with oral directions, written instructions are usually mailed to each patient before their ultrasound appointment.  You may expect many questions about these instructions. Patients may be a bit apprehensive about having an ultrasound performed. Understanding that each patient does not have your educational background in Ultrasound will allow you to compassionately explain the ultrasound process to them. If a patient wants to know why they must drink liquid, for example, explaining this lifts their bladder up may help them better understand the importance of their instructions.  Providing information to the patient allows them to calmly follow directions while alleviating any fears or concerns they may have.

There are several types of ultrasound that require preparatory directions. For many ultrasounds, the patient may need to wear a gown. Patients are instructed to wear comfortable clothing such as a sweat suit, comfortable pants and shirts. The patient will be asked to remove their garments, and wear a gown.  This allows the Ultrasound Tech to have access to the area of ultrasound, such as the abdomen, without working around tight-fighting clothing such as jeans.  Wearing comfortable clothing also allows the patient to change easily without the added hassle of tighter-fitting clothing or girdles.

Pelvic Ultrasound – There are three types of Pelvic Ultrasound: Abdominal, Vaginal and Rectal. Each has its own specific instructions for the patient.

Abdominal Ultrasound – (transabdominal)

This ultrasound covers the bladder, kidneys, urethra, liver, gall bladder and spleen, as well as reproductive organs.

The preparations for this ultrasound begin by asking the patient not to eat or drink anything after midnight. This is commonly referred to as NPO (nil per os). This is Latin for nothing by mouth; nothing to eat or drink.

For some types of abdominal ultrasounds, the patient will be instructed to drink three to four eight ounce glasses of water two hours before the ultrasound will begin. This will cause the bladder to become full. The patient may need to urinate but will be asked to refrain until after the ultrasound is performed.

A patient may question how to take their medication.  The Physician will determine if a patient takes necessary medication. If so, the patient will be allowed to take their medications with small sips of water.

Skin preparation is also important. The patient will be instructed to avoid lotions, creams, powders and perfumes.  It is important during the ultrasound process that the transducer have good conduct with the patient’s skin, and these products could interfere with the test.

Abdominal ultrasounds are performed while the patient is lying on their back. The Ultrasound Tech applies gel to the patient’s abdomen, which improves conductivity as well as provides smooth traction, and moves the transducer across the abdomen of the patient to obtain the ultrasound.

Vaginal Ultrasound  – (transvaginal )

This ultrasound covers the reproductive organs such as the uterus, vagina, cervix and ovaries.

A pelvic ultrasound is performed on the patients’ naval button to their pelvic bone. The patient will be asked to wear comfortable clothing, and will don a gown. This type of ultrasound is usually performed with a full bladder. The patient may be asked to void their bladder one and a half hours before the ultrasound. They will then be asked to drink up to four eight-ounce glasses of water or clear juice, and then refrain from voiding until after the ultrasound has been completed. This ensures the patient’s bladder becomes full. Once the bladder becomes full it lifts up out of the way of other internal organs, such as the intestines. If the patient’s bladder were not full, it would obstruct other organs from view.

The patient will be asked to lie flat on their back. Gel is placed on the abdominal area to ensure good contact with the skin. The transducer is then used to obtain the ultrasound, which shows a panoramic view of the patient’s pelvic region.

A transvaginal ultrasound indicates an ultrasound that is obtained through the vagina.

The patient will be asked to wear loose and comfortable clothing. The patient will be asked to remove clothing from the waist down. This allows them to wear their own garments from the waist up underneath the gown. Many patients prefer wearing their own shirts under a gown, allowing them a modicum of privacy.

This ultrasound is performed with the bladder empty, unless there are specific instructions from the Physician. Transvaginal ultrasounds are performed while the patient is in stirrups. The patient will be asked to lie down on a table on their back. They will then be instructed to move down, until their knees are bent. The patient’s feet are then placed in stirrups, cup-shaped holders that are attached to the table.

To perform transvaginal ultrasounds, the Ultrasound Tech first covers the transducer (probe) with a condom, and then applies gel to the condom. The transducer is then inserted into the patients’ vagina. The Ultrasound Tech can then gently manipulate the probe to ensure a clear ultrasound picture is obtained. Only the tip of the transducer (probe) is inserted into the patient’s vagina. This type of ultrasound is typically painless, although some patients may experience mild pressure from the insertion of the probe.

In certain cases, the patient’s uterus may need to be viewed more clearly. Saline-infused sonography, or SIS, is a type of transvaginal ultrasound that requires saline to be placed in the patient’s uterus before the ultrasound test. Saline is sterile salt water, and not harmful to the patient.  This type of test is not performed on pregnant women. SIS is also known as hysterosonography.

Rectal Ultrasound –

This ultrasound covers the tissue layers under the surface of the rectum such as the sphincter muscles. This can be useful in diagnosing muscle injuries, rectal polyps, rectal cancer, peri-anal infection, lesions, tears and scars.

The patient will be asked to wear loose and comfortable clothing. The patient will be asked to remove clothing from the waist down. This allows them to wear their own garments from the waist up underneath the gown.

The patient will be asked to use two enemas at home before their ultrasound. The first enema, two hours before the ultrasound, will empty the rectum. The second enema, taken one and a half hours before the ultrasound will ensure the rectum is completely empty. These enemas, taken thirty minutes apart, allow a clear ultrasound to be obtained.

The patient will be asked to lie on the table, and will then be asked to turn on his or her left side. The transducer, or probe, is covered with a condom, and then a small amount of gel is placed on the tip. The size of the probe that is inserted into the patient’s rectum is small – only the size of a finger. This allows a rectal ultrasound to be painless for the patient.

Breast Ultrasound –

This ultrasound is used to distinguish lumps, or masses from fluid-filled cysts. This type of type of ultrasound is useful if a patient has had a mammogram which indicates a lump or density, and / or the Physician can palpate (feel) a lump in the patient’s breast. The breast ultrasound can distinguish between a mass and fluid-filled area on the breast.

There is no preparation for a breast ultrasound, other than asking the patient to refrain from skin products such as lotions, perfumes or powders. The patient will be instructed to wear comfortable clothing to their ultrasound test. They will be asked to wear a gown that covers their upper half, and may continue to wear their clothing below the waist.

In certain cases, the additional use of a Doppler may be used along with the breast ultrasound. This allows the Physician to examine the blood flow, or lack of, in a suspected breast mass. This provides valuable diagnostic information in determining the origin of the mass.

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