Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji--a novel approach in a resource-poor setting.

We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses' skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses' results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions.

Coarctation of the aorta: a case presentation.

Coarctation is a constriction or narrowing of the aorta and presents most commonly within the first two weeks of life. This article reviews a case study of an infant diagnosed with coarctation of the aorta on day 8 of life. It includes an overview of the etiology, clinical presentation, and management plus an account of the infant's transport to a regional pediatric intensive care unit (PICU).

Focused Cardiac Ultrasound by Nurses in Rural Vietnam.

BACKGROUND: Multiple studies investigating the use of focused cardiac ultrasound (FCU) in lower and middle-income countries and in medically underserved areas of the United States have demonstrated utility in echocardiographic screening algorithms performed by a variety of operators at different levels of training. No study to date has employed previously untrained nurses in a medically underserved setting to identify older adults with cardiac disorders. The aim of this study was to assess the accuracy of nurse-performed FCU to screen adult subjects at a village health center in Vietnam. METHODS: Vietnamese nurses (N = 8) underwent structured training conducted by sonographers and physicians during an outreach event sponsored by the American Society of Echocardiography Education and Research Foundation. The nurses were trained to detect abnormalities from a single echocardiographic view (parasternal long-axis) with a laptop-sized device and underwent pre- and posttraining testing. Following training, cardiac ultrasound examinations were performed on subjects >50 years of age at a village health center. First, the nurses performed focused cardiac ultrasound using two-dimensional and color Doppler imaging in the parasternal long-axis view using the M7 device and recorded their assessments. Two-dimensional color and spectral Doppler echocardiography was thereafter performed using the same machine by a sonographer (n = 5) or a Vietnamese echocardiography-trained cardiologist (n = 1). Interviews and electrocardiography were performed at the time of FCU. RESULTS: Each nurse improved from pre- to posttraining (average improvement in correct answers, 21%; range, 2%-31%). During the scanning phase, nurses' sensitivity, specificity, and accuracy for identifying subjects with any abnormality were 51.5% (85 of 165), 78.1% (82 of 105) and 61.9%, respectively. There were 60 subjects with significant findings (22.2%); all of these subjects had significant abnormalities visible on parasternal long-axis images. Overall sensitivity, specificity, and accuracy for identifying subjects with major abnormalities were 83.3% (50 of 60), 78.1% (164 of 210), and 78.6%, respectively. Nurse-performed FCU demonstrated much higher sensitivity with lower specificity than electrocardiography alone. The combination of nurse-performed FCU plus ECG identified all of the significant findings on echocardiography and increased accuracy to 91.5%. CONCLUSIONS: Nurses with no prior echocardiographic experience and with limited training can identify patients with significant cardiac abnormalities using FCU with acceptable accuracy. Screening strategies involving FCU may play a role in improving access to health care and triage in underserved areas.

[Echocardiography in infirmary]. / Intervenciones de enfermería en ecocardiografía.

Cardiovascular diseases are the 1st death cause worldwide in the beginning of the third millennium. Due to its high incidence and fatal complications the study of ischaemic cardiopathy had great importance. Echocardiography is an image diagnostic technique, based on the use of ultrasound, applied in the evaluation and recognition of cardiovascular diseases. It is non invasive, harmless, accessible, easy to made and quick to interpret, safe and cheaper than others imaging techniques, its continuous development has allow its use in all cardiology fields. An area where the nursing staff begin their participation in the National Institute of Cardiology "Ignacio Chavez" is the Echocardiography Department where the nurse professional profile must embrace knowledge in different areas, with an active participation in the echocardiographic studies and protocols, optimizing the patient's quality of attention with the use of Nursing Attention Process based in the theory of Dorothea Orem with the aim of standardize and improve the patient's quality of attention along with the interdisciplinary team.

A Randomized Controlled Trial of the Use of Oral Glucose with or without Gentle Facilitated Tucking of Infants during Neonatal Echocardiography.

OBJECTIVE: To compare the effect of oral glucose given with or without facilitated tucking (FT), versus placebo (water) to facilitate image acquisition during a targeted neonatal echocardiography (TNE). DESIGN: Factorial, double blind, randomized controlled trial. SETTING: Tertiary neonatal intensive care unit (NICU). PATIENTS: Infants born between 26 and 42 weeks of gestation (GA). INTERVENTIONS: One of four treatment groups: oral water (placebo), oral glucose (25%), facilitated tucking with oral water or facilitated tucking with oral glucose, during a single, structured TNE. All infants received a soother. MAIN OUTCOME MEASURE: Change in Behavioral Indicators of Infant Pain (BIIP) scores. RESULTS: 104 preterm infants were randomized (mean ± SD GA: 33.4 ± 3.5 weeks). BIIP scores remained low during the echocardiography scan (median, [IQ range]: 0, [0 to 1]). There were no differences in the level of agitation of infants amongst the treatment groups, with estimated reductions in mean BIIP relative to control of 0.27 (95%CI -0.40 to 0.94) with use of oral glucose and .04 (-0.63 to 0.70) with facilitated tucking. There were also no differences between treatment groups in the quality and duration of the echocardiography scans. CONCLUSIONS: In stable infants in the NICU, a TNE can be performed with minimal disruption in a majority of cases, simply by providing a soother. The use of 25% glucose water in this context did not provide further benefit in reducing agitation and improving image acquisition. CLINICAL TRIAL REGISTRATION: Clinical Trials.gov: NCT01253889.

Transesophageal echocardiography: a new window on the heart and great vessels.

TEE adds an exciting new dimension to the field of echocardiography. It has expanded the physician's ability to clearly examine cardiac structures and bloodflow; in many instances it has been the means by which rapid and lifesaving diagnoses have been made. The nurse collaborates with the physician during TEE by ensuring adequate preparation, remaining at the patient's bedside to assist with and monitor the effects of probe insertion and ensuring close observation and postprocedural follow up. The complication rate for TEE is negligible. Possibilities include routine pediatric use, biplane imaging and incorporation with exercise stress testing.

Preparing for and understanding transesophageal echocardiography.

The transesophageal approach to cardiac echocardiography has expanded the ability of this (almost) noninvasive method of evaluating and diagnosing certain types of cardiovascular pathology. Its use can be expected to increase as echocardiographers become skilled in endoscopy and new applications are discovered.

Transesophageal echocardiography. Application to the postoperative cardiac surgery patient.

Surgical outcome after an open heart procedure can be appraised using traditional diagnostic tests. Transesophageal echocardiography (TEE) is gaining popularity as a technique for evaluating cardiac function after open heart surgery. Expert assessment skills on the part of the nurse at the bedside will impact on the successful completion of this semi-invasive diagnostic procedure.

The role of real-time ultrasound and physical examination measurements in placement of cuffed-tunneled hemodialysis catheters.

The portability of non-invasive ultrasound has resulted in an expansion of its utilization into a variety of clinical settings. Since ultrasound is recommended for initial vein cannulation during catheter placement, it is conceivable that ultrasound may also be used to verify catheter position. The purpose of this study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy. Determination of appropriate catheter length using physical exam measurements and verification of correct placement using portable ultrasound were examined. A total of 61 subjects, 31 with and 30 without a tunneled hemodialysis catheter underwent echocardiographic examination using the SonoSite 180PLUS (HCU; Bothell, WA) portable ultrasound. The investigator, using dynamic ultrasound imaging, was able to identify correct position in 30 of the 31 subjects with catheters. Still echocardiographic images were reviewed by two cardiologists and determined to be inconclusive. Physical examination measurements correlated well with the interventional radiologist guide-wire measurements (p < .01; r = 0.65) and concluded to be a useful method for determining appropriate cuffed catheter length.

[The communication process in the care of patients during echocardiography]. / O processo de comunicação no cuidado do paciente submetido ao eco-stress: algumas reflexões.

The article reviews some aspects of the communication process, its basic concepts, how it is approached in the theories of the nurses, and proposes to make reflections on the communication in the context of the patient undergoing the stress-echo study. Our goal is to emphasize and to rescue some important aspects related to the communication in health allies area, which is practiced in a constant manner in the daily practices of the nurse. Finally, this paper wishes to emphasize the importance of the knowledge of this process, incorporating it to the practice.

Cardiac diagnostic testing: what bedside nurses need to know.

Coronary artery disease affects more than 385000 persons annually and continues to be a leading cause of death in the United States. Recently, the number of available noninvasive cardiac diagnostic tests has increased substantially. Nurses should be knowledgeable about available noninvasive cardiac diagnostic testing. The common noninvasive cardiac diagnostic testing procedures used to diagnose coronary heart disease are transthoracic echocardiography, stress testing (exercise, pharmacological, and nuclear), multidetector computed tomography, coronary artery calcium scoring (with electron beam computed tomography or computed tomographic angiography), and cardiac magnetic resonance imaging. Objectives include (1) describing available methods for noninvasive assessment of coronary artery disease, (2) identifying which populations each test is most appropriate for, (3) discussing advantages and limitations of each method of testing, (4) identifying nursing considerations when caring for patients undergoing various methods of testing, and (5) describing outcome findings of various methods.

Implementation of critical congenital heart disease screening in Minnesota.

OBJECTIVE: To assess the level of preparedness and resources needed in Minnesota for the implementation of newborn screening for critical congenital heart diseases (CCHDs). METHODS: A cross sectional survey of all birth centers in Minnesota was performed to assess the capacity to deliver care essential for the CCHD screening program. Compliance with the screening algorithm, nursing workload, and cost were assessed by using a pilot program implemented in 6 normal newborn nurseries. RESULTS: Ninety-one of 99 eligible centers participated in the survey and 90 reported the ability to screen newborns in accordance with recommendations. Only 22 centers, with 63% of births, had access to echocardiography and routinely stocked prostaglandins for neonatal use. Our pilot study screened 7549 newborns with 6 failed screens and 1 CCHD diagnosis. Two of the failed screens were due to misinterpretation of the algorithm, 1 failed screen was not reported, and 4 failed screens were not recognized. Repeated screens were required for 115 newborns, with 29% of retesting due to misinterpretation of the algorithm. The mean nursing time required was 5.5 minutes, and the cost was $5.10 per screen. CONCLUSIONS: In Minnesota, two-thirds of newborns are born in centers with resources for initial diagnosis and management of CCHD. Implementation of a pilot screening program demonstrated minimal increase in nursing workload, but identified problems with interpretation of the algorithm and data reporting. This pilot project suggests the need for simplification of the algorithm, additional training of health care providers, and development of a centralized reporting mechanism.

Screening for cardiovascular disease in patients with advanced chronic kidney disease.

Cardiovascular disease remains the major cause of mortality and morbidity in patients with advanced chronic kidney disease (CKD) and after renal transplantation. The mechanisms for cardiotoxicity are multiple. Identifying high-risk patients remains a challenge. Given, the poor long-term outcome of dialysis patients who do not receive renal transplantation and the lower supply of donor kidneys relative to demand, optimal selection of renal transplantation candidates is crucial. This requires a clear understanding of the validity of cardiac tests in this patient group. This paper explores the strengths and weaknesses of currently available diagnostic tools in patients with advanced CKD. Echocardiography is very useful for the detection of cardiomyopathy and prognosis. Stress echocardiography, myocardial perfusion imaging and coronary angiography are the best tools for the assessment of coronary artery disease. All predict outcome. No single gold standard investigation exists. At present, there is not an optimal technique for predicting sudden cardiac death in this patient group. Ultimately, the choice of cardiac test will always be determined by patient preference, local expertise and availability.