is dave i'm with boston scientific uh nicos is one of the devices boston scientific has to offer um and the physicians here have been using ecos for over 10 years now here at mercy hospital and what they use ecos for is they use this on patients with thrombus issues okay so they use it to treat patients with different types of products some clot can be in your sfa your arterial leg arteries you know some can be dvts or ibc inclusions in your veins and some could be pulmonary embolisms okay and depending on what they treat is where they get access with a six front sheath okay so you might see patients come over with a sheath in their arm or behind the leg or in the groin wondering why are they in different places so it's because they're treating different things so usually for your arterial um thrombus cases they'll get axis in the opposite groin of the leg they're treating so if we're treating the left leg axis in the right groin and vice versa once in a great while you might seem good access to the brachial artery and go up around the aortic arch and balance the yarn on that way um for deep vein thrombosis cases you'll usually see them good access in the popliteal vein behind the knee because the clots usually light here and sometimes you'll see the um they'll get access maybe even the brachial vein like a subclavian vein clot here um and then the last thing is uh pulmonary embolisms okay so polar embolisms 98 of the time um involve both the right and the polar arteries so you'll see them get accessed with two sheaths in the same femoral vein okay if the right femoral vein is occluded with clot then they'll get an access with the in the left okay because 50 of the pes out there actually come from dvts so that's why you might see them have caught in there now what they'll do is take get access you know with the wire and they'll put ecos catheter up and part a section of this catheter directly within the clot now there's different lengths of ecos catheters that can range from 12 centimeters all the way to 50 centimeters in length okay and depending on what they are treating is what the size they'll use and you don't have to remember the sizes that they are like this particular one i think is a 50 yeah so between my fingers here are a bunch of little tiny side holes okay and what we're able to do is we're able to infuse the tpa through the catheter and the tp's gonna go through the catheter and exit the little side holes and go directly into the clot so like the 50 centimeter catheter is going to usually use for like a leg case okay whereas like a 12 centimeter eco scatterer will not only be used for our pe case on top of that infusion of cpa there's little dark bands inside the catheter those little dark bands are ultrasound transducers that emit ultrasound during the whole infusion time period and the reason why we do that is because in the late 90s they did several studies which show that when clots exposed to low power ultrasound the fibrin strands that actually make up the structure of the cloth separate and when that happens the cloth becomes more porous like a sponge okay allowing more surface area of the cloth to be exposed to the tpa and that allows the tpa to work much more effectively and efficiently and because of that we infuse a lot less tpa and then therefore it's much safer for patients because tpa works great okay it's awesome at dissolving time probably tpas it can be dangerous and cause bleeds because we're getting much less at less time it reduces the um bleed rates and ich rates down to almost the same rate of getting heparin itself we just actually had a study of 489 patients for zero ichs um so getting back to the catheter here we have two ports that are always going to be labeled one's gonna be labeled drug and the other one's gonna be labeled coolant okay for every catheter that is used on a patient we're gonna have one brain and three channels okay so remember for those five lpe cases we'll use two catheters so you'll have two brains and then six total channels one channel that will be infusing tpa should always be hooked up to the drug corps on the catheter that's really important to note when the patient comes over from the alarm okay the second channel labeled normal ceiling or coolant should always be hooked up to the coolant port and what's running through there is 0.9 normal sanding room temperature and the purpose of that normal setting is just to cool those little transducers that you saw inside the catheter okay the transitions don't get super hot to where it's going to burn the patient it just allows them to work more efficiently and then we have a third channel here labeled heparin if i'm wondering where is that gonna go because there's only two ports so remember i talked about the access site with the six french sheath that six front sheath will have a side port to it and we're going to hook up the headline to that and the purpose of that heparin is to actually make for maintenance for the sheath okay it could run i've seen them as low as 300 units an hour to a times 1000 units an hour it's depending on what we're doing with this bilateral or unilateral or what we're treating in the size of the patient as well right you never ever want to aspirate from these two ports all right the staff over the er they always have three-way stock box on these okay so if you ever did need to flush it you can easily flush it if needed but i think it's gonna be very rare for this to include on here because they flush these right away and they hook everything up right away unless these stop running for some time period you should never include i mean especially at the tpa part right coming off the back of our catheter are two wires one is gray one is black go into two plugs gray and black and it's going to plug into the corresponding colors and shapes okay just like those placeable games and this will be normally kept in bed with the patient because this poor's about eight foot long okay now i talked about making sure the tpa is hooked up to the drug port now we want to make sure what we look for on the on the epos machine okay and what we want to make sure is that when they arrive there's a little yellow flashing light right down here in the left-hand corner okay this is the older equals machine they also have a newer version which you can power two catheters with one machine on the new on the new epos machine there will be a channel a and a channel d on the screen with two of these setups here okay uh there'll be two start and stop buttons for each channel okay so if you don't see a yellow session light here i hit the green start button on a new machine it should say on the screen running with enemy and sound waves on this one you'll see the yellow question light with animated sound waves on the ecos logo and a lot of times the physicians here like to have a graph up here this graph you don't need to chart anything on don't you don't need to worry about it if the physician called and asked you what is the graph reading at you know if it was if you read what this number this line is at so if it was at sixty percent say sixty percent and this just keeps track of the power of the ultrasound over a time period so as this goes to you know two minutes to five to five minutes and 15 minutes to 38 hours you'll see a graph starting to be plotted on here if this alarms there's a silence button next to this megaphone here hit the softkey next to the megaphone it'll circle in red or by putting red x in red where the prop would be located but more importantly there's going to be error codes flashing on the bottom of the screen here okay and the reason why those are important because we have a 1 800 number down on top of this battery on the new eagles machine it's a touch screen on the top there's a little eye that will bring you to the information screen and that's where the one in 1 800 number will be on that one so you'll call us and say hey i have an issue and we're going to ask you what the eric woods look like okay that'll allow us to diagnose why it's alarming in this case we'll just plug this back in since we know why it alarmed it's gonna go and check and make sure everything is okay and once it realizes everything is okay it will beep a couple times just like that and flash the green start button on the screen to remind you to restart it so we'll go ahead and hit start if you want to when you receive a page on this just to make sure everything is working just hit the start button no matter what you can make it your own policy if you want if you ever need to stop ultrasound guess which one you hit this top button yeah there we go and it's going to be the same thing on the on the new machine except for the new machine you have two catheters so they need to hit the one stop button and the second stop button um you'll also notice that when i restarted this it went to a different screen so to get back to that draft screen just hit the little little soft key next to the squiggly button here and i'll go back to the graph so i'm going to stop again to stop the ultrasound okay and then you won't need to do this but for some reason you need to detach the catheter for some reason just unplug it here okay don't unplug it here this is disposable this is not the last thing is this white box down below is a battery um just make sure this gets plugged in just like anything else rotation arrives on the new machine the battery is actually inside the little box it's all with the amino battery and i think that's about it any questions how long does the battery last that's a great question i would say you'll be safe for a half hour for sure and this supposedly an hour but i'd say half hour you're safe and for some reason this battery ever went dead and this machine quit working because the power is now dead um there's actually this this ecos is actually plugged into the back of the battery via this cord here so you can unplug it from the back of the battery and just plug it in directly into your wall outlet no no because your infusion pumps that are infusing or are separate from what the us is building a good question yeah and the removal of the ecos catheters like that only the icu nurses are competency to do that so for watching people overnight need to have that removed the icu has come over and does that so we are not going to be competency to do that but just so you know that usually for the like cases they'll bring the patient back to the or the movement of the catheters but for the people they always remember in the icu okay and the pe ones are usually only running for six hours and the leg one's usually 24 then they return for the eco recheck the next day for that 24 hours what's involved with the wrong tech they do they usually uh they'll remove the catheter and do a vienna gram or angiogram uh to visualize the teleclass been dissolved and that usually uncovers why they climb off usually there's a lesion that's not equation there or the balloon angioplasty or they may have to extend the spent or put a stent in okay any questions any more questions that's great all right thank you thank you