key: cord-0932170-mwrhbr4r
authors: Lin, Wang‐Sheng; Killeen, David; Yang, Chen‐Ya
title: Point‐of‐Care Ultrasound Is a Valuable Modality During Mass COVID‐19 Vaccination Campaigns
date: 2021-11-05
journal: J Ultrasound Med
DOI: 10.1002/jum.15865
sha: 4e2ca83256ce04223213e6213df04f68fb042c38
doc_id: 932170
cord_uid: mwrhbr4r

nan

To the Editor: We would like to thank Dr. M ungmunpuntipantip for the insightful comments on our article titled "Point-of-care ultrasound is a valuable modality during mass COVID-19 vaccination campaigns. " We are grateful that we were offered an opportunity to reiterate and clarify our argument.

One concern raised by Dr. Mungmunpuntipantip was that performing point-of-care ultrasound (POCUS) assessments, for appropriate needle-length selection, prior to vaccination procedures is not practical. Admittedly, mass vaccination campaigns focus on efficiency and streamlining of the workflow. Performing POCUS on each individual during a vaccination campaign would be a challenging task; however, we believe that its feasibility and cost-effectiveness warrant further investigation. In fact, our article proposed utilizing POCUS selectively to guide individualization of needle length, especially for special patient populations in which the current guidelines might be not reliable. Moreover, we did not advocate using POCUS for ultrasound-guided injection purposes. Therefore, the amount of time required for POCUS assessment would be minimal, especially for skilled operators. It should be noted that using ultrasound to determine needle length has already been proposed and documented for Japanese infants during vaccination. 1 The other concern raised by Dr. Mungmunpuntipantip was that the POCUS assessment might increase the risk of COVID infection. However, even though COVID transmission is primarily via airborne routes and droplets, and POCUS assessment of the skin-to-muscle distance is rather quick, we still encourage healthcare providers to take precautions that include using probe covers and disinfecting the surfaces of the ultrasound machine that come into contact with either the patient or the clinician with a low-level disinfectant (ethyl or isopropyl alcohol, 70-90%). 2 Because the handheld POCUS is compact in size, sterilization of the transducer and the machine is relatively easy; this makes POCUS a widely used diagnostic tool, especially during the COVID pandemic era. 3 Adverse events due to improper needle placement have been reported since vaccination programs were implemented worldwide. 4, 5 The importance of individualizing needle length as part of the vaccine injection routine has been well-supported and reiterated among experts in vaccination research. 6 However, until now, the only criteria for determining needle length are based solely on body weight and body mass index and disregards a patient's ethnicity, pre-existing conditions, or past medical history. 7 POCUS is recognized as a noninvasive, cost-effective, real-time, and readily accessible tool in clinical settings, and it can serve as an alternative modality for preventing not only the consequences of improper needle selection but also potential legal liability related to unintended adverse events that result from vaccine administration. 8 We hope that our response clarifies our argument for using POCUS and encourages healthcare allies to utilize POCUS for optimizing vaccination practices during the age of COVID-19.

Appropriate needle lengths determined using ultrasonic echograms for intramuscular injections in Japanese infants

Quick Guide on COVID-19 Protections-Ultrasound Transducers, Equipment, and Gel. Laurel, MD: American Institute of Ultrasound in Medicine

Point-of-care ultrasound in COVID-19 pandemic

Combined subacromialsubdeltoid bursitis and supraspinatus tear following a COVID-19 vaccination: a case report

Shoulder injury related to Sinovac COVID-19 vaccine: a case report

Shoulder injury related to vaccine administration and other injection site events

Vaccine administration: intramuscular (IM) injection adults 19 years of age and older

A systematic review of the cost-effectiveness of ultrasound in emergency care settings