Improvised POCUS gel using a Sandwich bag

As a Remote Medic, we often work with limited equipment and resupply. The best ultrasound gel is a single-use, sterile gel. So make sure that you have that option. But if you run out or don’t have any gel options, you can just use water. The best option for just water is to fully submerge your probe and body parts in water. But we can’t do that for most of the body’s surface.

There is an option. Place your probe into a sandwich bag and fill it with enough water to cover the end of the probe. Tape the bag around the probe and use it for your assessment. I have used this with the IQ, IQ+, and the IQ3. The newest version is by far the best option with this technique. Here is a picture of a student using this option during an Austere Emergency Care course in Norway.

In ultrasound imaging, achieving effective transmission of sound waves between the transducer and the skin is crucial. Commercial ultrasound gel serves this purpose by eliminating air pockets that impede sound wave conduction. Alternative coupling methods have been explored in situations where ultrasound gel is unavailable. One such method involves submerging the area of interest and the ultrasound probe in water, known as the water bath technique. This approach has been documented to provide clear imaging of superficial structures without the need for gel, as it eliminates air interfaces that can degrade image quality.

Another innovative method involves using a flexible gel pad as a coupling medium. A study published in the Canadian Journal of Anesthesia demonstrated that a flexible gel pad can effectively conform to irregular anatomical surfaces, providing consistent contact and reducing air gaps between the probe and the skin. This technique resulted in ultrasound images of comparable quality to those obtained using traditional gel, offering a viable alternative in austere settings where gel is scarce.

Additionally, research has investigated low-cost, locally sourced alternatives to commercial ultrasound gel. A study in PLOS ONE applied a human-centred design to develop an alternative gel using materials like cassava root flour and salt. The resulting mixture was tested in the field, and ultrasound images of similar quality were produced to those obtained with commercial gel. This approach highlights the potential for sustainable and accessible solutions in resource-limited environments.

While these alternatives show promise, it's important to note that each method may have limitations regarding image quality, ease of use, and sterility. For instance, the water bath technique may not be practical for all anatomical areas, and homemade gel formulations may vary in consistency and effectiveness. Therefore, when employing such alternatives, carefully considering the specific clinical context and adherence to infection control protocols are essential to ensure patient safety and diagnostic accuracy.

The Bottom Line: Be a Better Medic. Learn improvised ultrasound options.