Original seven-case description. Painless evaluation and improved images when direct contact remained intolerable despite analgesia.
If touching the anatomy hurts or distorts it, stop pressing on it. Water becomes the coupling medium and standoff pad.
Best for a focused question in painful, superficial, irregular anatomy. Think fingers, hands, toes, and feet.
Built from the original seven-case emergency medicine description, current ACEP Sonoguide technique, and AIUM 2025 infection-control guidance.
Use the highest frequency that still reaches the target. A hockey-stick probe works well when available.
Set the focal zone at the structure. Keep the target centered, not buried at the top edge.
Use a clean basin. Let bubbles settle. Support the extremity so the patient can stay still.
Probe manual first. Basin second.
Confirm how much of the transducer can be submerged. Keep the cable junction and connector dry unless the manufacturer explicitly permits immersion.
Comfortable water. Supported extremity. Quiet surface.
Submerge the painful anatomy. Support it in a position the patient can hold. Sweep bubbles off the skin and wait for the water to settle.
No skin contact. Two orthogonal planes.
Submerge the probe face and hover several millimeters above the skin. Sweep slowly in long and short axis. Keep the beam perpendicular to tendon fibers and suspected foreign bodies.
Active first. Gentle passive motion if needed.
Watch tendon fibers glide through the field. A static tendon image can miss a functional discontinuity or adhesion. Stop if motion is unsafe or intolerable.
Labels. Stills. Clips. Measurements.
Save the target in two planes. Record dynamic clips for tendon questions. Label laterality and site. Document image quality and the focused limitation.
| Question | What to look for | What to record |
|---|---|---|
| Foreign body | Hyperechoic focus with shadowing or reverberation. Confirm in two planes. | Length, skin depth, orientation, nearby tendon or vessel |
| Tendon | Fibrillar continuity plus active or passive gliding. | Continuity, motion, retraction, sheath fluid |
| Collection | Focal fluid, debris, septations, or surrounding cobblestoning. | Three dimensions, depth, surrounding structures |
| Cortex | Smooth bright cortical line. Step-off or interruption is suspicious. | Exact site and two-plane confirmation |
| Small joint | Capsular distention or fluid compared with the opposite side. | Joint, distribution, dynamic change |
Foreign-body localization, not bath-guided incision.
Measure depth from the skin surface, not from the probe or top of the image. Define orientation and proximity to tendon, joint, nerve, and vessel. Mark the skin after the anatomy leaves the water. Use the sterility required for any subsequent incision or needle procedure.
The displayed image begins at the probe. The tissue does not. Measure target depth from the skin line after the water column.
Air creates bright artifact and dirty shadowing. Sweep bubbles away, settle the bath, and confirm every target in a second plane.
A tendon turns dark when the beam is oblique. Heel-toe until the fibrillar pattern returns before calling discontinuity.
Place the hand inside a thin-walled polypropylene container and scan through its side. A small 2024 comparison found better hand-image ratings than the classic bath. Promising technique, not established standard.
A focused note for the question you actually scanned. Blue fields are wildcards. Delete findings you did not assess.
POINT-OF-CARE ULTRASOUND: WATER BATH Indication: [clinical question] Site / laterality: [site] Exam type: focused / limited bedside ultrasound Operator: @ME@ Interpretation: independent, real-time Probe: high-frequency linear Technique: water-bath standoff; no direct probe contact The area was examined in two orthogonal planes [with dynamic assessment]. Foreign body: [none visualized / echogenic foreign body] Size: [ ] mm Depth beneath skin: [ ] mm Artifact / relation to adjacent structures: [ ] Fluid collection: [none / present, dimensions and depth] Tendon: [preserved / disrupted] continuity; motion [preserved / abnormal] Cortex: [smooth / focal disruption at] Joint effusion: [none / present at] IMAGE QUALITY: [adequate / limited by] Images saved and archived to [PACS / Qpath / other]. IMPRESSION: [ ] LIMITATION: This focused examination does not exclude [specific limitation]. I personally performed and interpreted this study in real time. Electronically signed: @ME@ @TD@ @NOW@
Sample template only. Verify wording, image archival, billing, credentialing, and infection-control requirements against your department policy.
Original seven-case description. Painless evaluation and improved images when direct contact remained intolerable despite analgesia.
Current technique guidance for superficial structures, hands, feet, foreign bodies, and dynamic tendon assessment.
Manufacturer immersion limits, covers for contaminated skin, low-level disinfection, and equipment handling.
Small image-comparison study of the lateral bath. Better ratings for quality and clinical adequacy than the classic technique.