Evaluation of a Point-of-Care Ultrasound Educational Program for Nurse Educators.

BACKGROUND: The effectiveness of point-of-care ultrasound (POCUS) for nurses has been demonstrated; however, only a limited number of nurses have been trained to perform POCUS. This article reports on a POCUS train-the-trainer program for nurse educators that targets lower urinary track dysfunction. METHOD: Nurse educators (n = 38) were invited to participate in a POCUS train-the-trainer program, which comprised an e-learning module and a hands-on seminar. Acquisition of knowledge and skills were assessed after the module and seminar, respectively. RESULTS: Questions from the "Basic Knowledge of Ultrasonography" test were answered correctly at a rate of 93.0% (SD, 8.5%). Measured values of bladder urinary volume using ultrasonography were in close agreement with actual values. All of the participants indicated that the program covered the content necessary to use in practice. CONCLUSION: The POCUS train-the-trainer program equips nurse educators with the knowledge and skills needed for training nurses at their institutions. [J Contin Educ Nurs. 2021;52(8):375-381.].

Using point-of-care ultrasound in nursing.

ABSTRACT: In this article, the author examines the use of point-of-care ultrasound in nursing practice, including its benefits, clinical implications, and cost-effectiveness for nursing practice and healthcare systems in the long run.

Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study.

BACKGROUND: Paediatric distal forearm fractures are a common ED presentation. They can be diagnosed with point-of-care ultrasound (POCUS) as an alternative to X-rays. Given that ED nurse practitioners (NPs) are relied on for the diagnosis of paediatric fractures, it is important to describe the diagnostic accuracy of NP-conducted POCUS versus X-ray. METHODS: This prospective diagnostic study was conducted in a tertiary paediatric hospital in Queensland, Australia, between February 2018 and April 2019. Participants were children aged 4-16 years with a clinically non-angulated, suspected distal forearm fracture. Diagnosis from 6-view NP-administered POCUS of the distal radius and ulna was compared against the reference standard of 2-view X-ray. Each patient received both imaging modalities. Overall forearm diagnosis was classified as 'no', 'buckle' or 'other' fracture for both modalities. The primary outcome was diagnostic accuracy for 'any' fracture ('buckle' and 'other' fractures combined). Secondary outcomes included diagnostic accuracy for 'other' fractures versus 'buckle' and 'no' fractures combined, and pain, imaging duration and preference for modality. RESULTS: Of 204 recruited patients, 129 had X-ray-diagnosed forearm fractures. The sensitivity and specificity for NP-administered POCUS were 94.6% (95% CI 89.2% to 97.3%) and 85.3% (95% CI 75.6% to 91.6%), respectively. 'Other' fractures (mostly cortical breach fractures), when compared with 'buckle'/ 'no' fractures, had sensitivity 81.0% (95% CI 69.1% to 89.1%) and specificity 95.9% (95% CI 91.3% to 98.1%). Pain and imaging duration were clinically similar between modalities. There was a preference for POCUS by patients, parents and NPs. CONCLUSIONS: NP-administered POCUS had clinically acceptable diagnostic accuracy for paediatric patients presenting with non-angulated distal forearm injuries. This included good sensitivity for diagnosis of 'any' fracture and good specificity for diagnosis of cortical breach fractures alone. Given the preference for POCUS, and the lack of difference in pain and duration between modalities, future research should consider functional outcomes comparing POCUS with X-ray in this population in a randomised controlled trial.

Assessing Postvoid Residual to Identify Risk for Urinary Complications Post Stroke.

BACKGROUND: After a stroke, urinary dysfunction and urinary tract infection are estimated to be approximately 20%. Increased postvoid residual (PVR) is a risk factor for urinary dysfunction and urinary tract infections. These complications can negatively impact recovery weeks after the initial hospitalization. Early identification of risks and patient education are important. PROJECT DESCRIPTION: This project was initiated for those patients admitted for a diagnosis of stroke on a 55-bed neuroscience unit in an acute care hospital. Patients were scanned after the initial void post stroke. Nurses followed a specific bladder scanning algorithm for subsequent scanning if the PVR volume was greater than 100 mL. RESULTS: Seventy-eight patients were scanned in the original phase of the project, and 41 (53%) had PVR volumes greater than 100 mL after the initial void/scan. Of those, 22 patients still had a volume of greater than 100 mL after the second void/scan, and 12 had PVR volumes greater than 100 mL after a third scan. IMPLICATIONS FOR PRACTICE: Patients admitted with stroke have demonstrated increased PVR volumes. Portable ultrasound bladder scanning is a safe, noninvasive method to measure residual urinary volumes. The use of a bladder scanning algorithm encourages nurses' autonomy in assessing and identifying patients at a higher risk for urinary complications. CONCLUSION: Identifying the risk for urinary complications post stroke can lead to early interventions that can improve recovery. This also allows for specific patient education related to preventative measures to reduce risk of urinary complications. The use of a specific bladder scanning protocol is recommended as standard practice for all patients admitted with stroke.

A prospective cohort study of predictors of upper extremity arteriovenous fistula maturation.

BACKGROUND: A substantial proportion of arteriovenous fistulas fail to function adequately for hemodialysis. Existing studies on arteriovenous fistula failure prediction assess patency rather than the more clinically relevant outcome of arteriovenous fistula function. We hypothesized that preoperative demographic and ultrasound characteristics, and postoperative assessment by an experienced vascular access nurse would predict which arteriovenous fistulas will not function adequately for hemodialysis. METHODS: Prospective cohort study of chronic kidney disease patients at a tertiary care center in Vancouver, Canada, with arteriovenous fistula creation between 2009 and 2013. Pre and postoperative clinical assessment and ultrasound blood vessel mapping were performed by an experienced vascular access nurse. The primary outcome was failure to achieve a fistula used successfully for hemodialysis (FUSH). RESULTS: Outcomes were assessed in 200 patients; 123 (61.5%) arteriovenous fistulas were radiocephalic. Overall, 26.5% of arteriovenous fistulas had FUSH failure (34.1% of lower arm vs 14.3% of upper arm, p = 0.002). Univariate predictors of FUSH failure included older age (p = 0.03), female sex (p = 0.05), smaller arterial diameter (p ⩽ 0.001), lower artery volume flow (p = 0.04), and smaller vein diameter (p = 0.01). In multivariable analysis, artery diameter (odds ratio: 0.44, 95% confidence interval: 0.28-0.68) most significantly predicted FUSH failure. Vascular access nurse assessment 6 weeks postoperatively correctly predicted outcome in 83.8% of FUSH and 65.0% of FUSH failure. CONCLUSION: Smaller artery diameter most strongly predicted FUSH failure. Early postoperative nursing assessment was more useful to predict FUSH than FUSH failure, and as such was insufficient in determining which arteriovenous fistulas should be abandoned as many predicted to fail could be salvaged with further intervention.

Brief training increases nurses' comfort using tele-ultrasound: A feasibility study.

BACKGROUND: Nurses and other non-physician providers have demonstrated proficiency at obtaining images in the tele-ultrasound system. However, use of this skill requires comfort with the procedure and willingness to incorporate it into practice. OBJECTIVES: To assess 1) level of comfort of non-physician providers performing tele-ultrasound before and after brief training and 2) feasibility of implementing an educational programme that improves level of comfort. METHODS: Feasibility study including a brief training session followed by hands-on tele-ultrasound. The pilot cohort performed tele-ultrasound on a healthy volunteer. The clinical cohort performed tele-ultrasound on criticalli ill patients with shock or respiratory failure. Remote intensivists provided real-time guidance via tele-medicine technology. Each participant completed a survey assessing training experience and level of comfort before and after training. RESULTS: Sixteen non-physician providers participated. All participants agreed that the training session prepared them for image acquisition and that the training experience was positive. The number of participants comfortable with ultrasound improved significantly (before vs. after training: 5/16 [31%] vs. 16/16 [100%], mean Likert score 2.7 vs. 4.8, p = 0.001). CONCLUSIONS: After brief training, participants could comfortably perform tele-ultrasound and were more willing to incorporate it into tele-ICU-directed care. Results support conducting a larger-scale trial of tele-US to assess clinical utility.

Brief report of a novel advanced practice provider-led course for ultrasound novices.

BACKGROUND AND PURPOSE: Formal training for ultrasound use is essential for critical care providers. Despite a national increase in the utilization of advanced practice providers in critical care, ultrasound education is not routinely provided in their training programs. This study describes and evaluates a 1-day advanced care provider (APP)-led course designed to provide fellow APPs with the skills to obtain and evaluate basic ultrasound images. METHODS: A 15-question pretest was administered via anonymous use of a clicker response system. Participants had didactic lectures followed by hands-on experience with live models and instructor. Posttest was administered after achievement of basic ultrasound views. Postcourse evaluations were also administered. CONCLUSIONS: Pretest and posttest questions included identifying anatomy, pathology, quantifying cardiac function, and clinical decision making. Scores improved from 58% on the pretest to 78% on the posttest. All participants acknowledged the need for the course and their ability to transfer the course into practice. IMPLICATIONS FOR PRACTICE: This course established that APPs can both teach and learn from their peers in a formal setting. In addition, this course demonstrated that an APP-led course with a combined hands-on and didactic approach is an effective method for critical care ultrasound skills acquisition in ultrasound-novice APPs.

Clinical Application of Point-of-Care Ultrasound Gastric Examination in the Management of an ASA Class 3E Patient: A Case Report.

A 79-year-old ASA class 3 patient scheduled for outpatient testing secondary to prostate cancer, was found to have a previously unknown 10-cm abdominal aortic aneurysm (AAA) causing acute renal insufficiency and hydronephrosis, requiring prompt surgical intervention. The patient was instructed to return to the hospital for further evaluation of the AAA and emergent ureteral stent placement. During the preanesthetic examination, the patient revealed he had eaten a small amount of food before returning to the hospital, placing him at increased risk of pulmonary aspiration. Traditional fasting times would have warranted either a delay in starting the case or performing it under general anesthesia with an endotracheal tube, both at increased risk to the patient. Instead, a point-of-care ultrasound gastric study was performed at the bedside to assess for gastric contents, which revealed the stomach was empty. The case proceeded under monitored anesthesia care without incident. A metallic stent was successfully employed, correcting the hydronephrosis and allowing for further evaluation and treatment of the AAA.

Use of ultrasound by registered nurses-a systematic literature review.

BACKGROUND: In Western Australia (WA), most stable patients undergoing haemodialysis receive treatment in a satellite setting where no doctors are on-site during treatment hours, so nurses must make critical decisions about fluid removal. Some patients regularly experience adverse events during dialysis (intradialytic), often due to excessive ultrafiltration goals, with intradialytic hypotension being particularly challenging. Ultrasound of the inferior vena cava has been previously demonstrated being a rapid and non-invasive method for volume assessment on haemodialysis patients, thus could hold valuable information for the treating nurse. AIM: This paper examines the existing literature in regards to the use of ultrasound measurements of the inferior vena cava in patients on haemodialysis for objective assessment of their intravascular volume status by renal nurses. METHOD: A systematic literature review was performed within medical and nursing databases including CINAHL Plus with Full Text, SCOPUS, Web of Science and MEDLINE. RESULTS: Renal nurses are conscious of the significance of intradialytic hypotension and have only limited options for its prevention. Ultrasound of the inferior vena cava could add another objective dimension for intravascular volume assessment and prevention of intradialytic hypotension, but to date renal nurses have not been using this technique. CONCLUSIONS: Ultrasound of the inferior vena cava has the potential to assist in defining the ultrafiltration goal for that particular dialysis session, thus reducing the risk of intradialytic hypotension. Additionally, it has potential to change current renal nursing practice when added to clinical nursing assessment methods. Further studies are required to validate this assessment tool carried out by a renal nurse compared with a skilled ultrasonographer.

¿Qué utilidad tiene la ecografía para enfermería en el niño crítico? / What is the utility of the ultrasound for nursing in the critical child?

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Clinical Agreement between Nurses in the Ultrasound Measurement of Abdominal Aortic Diameter within a National Screening Programme.

BACKGROUND: Accurate measurement is central to abdominal aortic aneurysm screening, but information concerning differences between observers using modern ultrasound devices is lacking. Our aim was to assess clinical agreement among nurses within a national screening programme. METHODS: Between-observer repeatability was assessed among 2 pairs of nurses (A & B and C & D) screening a consecutive series of men at a single-community clinic in Grampian, Scotland. All 4 nurses used the same ultrasound device (GE-LOGIQe 1.5-4.6 MHz curvilinear probe) to measure maximal infrarenal inner-to-inner (ITI) anteroposterior diameter in longitudinal and transverse planes. Nurses alternated in their measurements and were blinded to their partners' measurements. Participants remained supine while "double-scanned." Clinical agreement was assessed as twice the standard deviation (2 SD) of mean differences. Analysis was undertaken using IBM-SPSS-Statistics (version 22) using the Bland-Altman "limits of agreement" (95% LoA) approach (mean difference ±2 SD) and related plots. RESULTS: A total of 63 consecutive men underwent assessment (30 men by nurses A & B; 33 men by nurses C & D). Mean age 65.5 years, brachial blood pressure 145/88 mm Hg, current smokers 14%, never smoked 41%, diabetic 18%, arterial disease 11%, daily aspirin 16%, antihypertensives 35%, and statin therapy 44%. Mean aortic diameter (ITI) was 1.81 centimeters (cm; range 1.28-2.45; SD 0.18). Pooled mean differences between nurses was 0.05 cm (95% confidence interval 0.02-0.08); 2 SD ± 0.23 with 95% LoA -0.18 to 0.28 cm. Repeatability was similar in both planes and for both pairs of nurses. CONCLUSIONS: Nurses can achieve a high level of agreement in the measurement of aortic diameter in a routine clinical setting.

Hidatidosis paravesical. Presentación de un caso clínico / Bladder hidatidosis. Presentation of a clinical case

La hidatidosis primaria pélvica o paravesical es una forma excepcional de presentación de la enfermedad, mucho más común en pulmón, hígado y riñón. La clínica suele corresponder a trastornos irritativos miccionales. El diagnóstico de imagen es por ecografía, TAC y RNM. La serología es complementaria. El tratamiento médico es con albendazol pero la solución definitiva del quiste hidatídico paravesical es la cirugía. Se presenta un caso clínico de quiste hidatídico paravesical tratado con cirugía abierta, con una breve revisión de la literatura (AU)

Primary pelvic or paravesical hydatid disease is an exceptional presentation of the disease, more common in lung, liver and kidney. The symptoms are typically for irritative micturition disorders. The image diagnosis is by ultrasound, CT and MRI. The serology is complementary. Albendazole is pharmacological treatment but the final solution for the paravesical hydatid cyst is surgery. We present a case of paravesical hydatid cyst treated with open surgery, with a brief review of the literatura (AU)

Polyclonal outbreak of bacteremia caused by Burkholderia cepacia complex and the presumptive role of ultrasound gel.

A nosocomial polyclonal outbreak associated to bacteremia caused by different Burkholderia cepacia complex (BCC) species and clones is reported. Molecular characterization identified Burkholderia stabilis, Burkholderia contaminans, and Burkholderia ambifaria among BCC isolates obtained from patients in neonatal and adult intensive care units. BCC was also isolated from an intrinsically contaminated ultrasound gel, which constituted the presumptive BCC source. Prior BCC outbreak related to contaminated ultrasound gels have been described in the setting of transrectal prostate biopsy. Outbreak caused strains and/or clones of BCC have been reported, probably because BCC are commonly found in the natural environment; most BCC species are biofilm producers, and different species may contaminate an environmental source. The finding of multiple species or clones during the analysis of nosocomial BCC cases might not be enough to reject an outbreak from a common source.

Comparison of outcomes between ultrasonography and cystoscopy in the surveillance of patients with initially diagnosed TaG1-2 bladder cancers: A matched-pair analysis.

PURPOSE: To examine the clinical outcomes of regular use of ultrasonography when compared with those of cystoscopy in the follow-up of patients with TaG1-2 bladder tumors. PATIENTS AND METHODS: Between 1990 and 2012, 197 patients with TaG1-2 bladder tumors from a retrospective 2-institution cohort were included. We assessed clinical outcomes in 83 patients followed up by ultrasonography, matched for propensity score calculated from clinicopathological variables including age, gender, tumor multiplicity, size, grade, postoperative immediate chemoinstillation, and adjuvant intravesical treatment. RESULTS: Among the 166 patients identified using the one-to-one propensity score analysis, the 5- and 10-year recurrence-free survival rates were both 63.3% in the cystoscopy group and 69.1% and 58.4%, respectively, in the ultrasonography group (P = 0.762). A total of 54 patients experienced disease recurrence, and 18 patients acquired progressive disease such as tumor grade 3, pT1 tumors, and the appearance of concurrent carcinoma in situ. There were no significant differences in the characteristics of recurrent tumors between both the groups, whereas time to first recurrence in the cystoscopy group was significantly shorter than that in the ultrasonography group (P = 0.021). In a subgroup analysis using 111 patients without adjuvant intravesical treatments, the 5- and 10-year recurrence-free survival rates were both 56.9% in the cystoscopy group and 71.9% and 60.3%, respectively, in the ultrasonography group (P = 0.282). CONCLUSIONS: This retrospective study suggests that ultrasonography may be one of the follow-up substitutes when considering the management of low-risk bladder tumors such as TaG1-2 bladder tumors.

Razones para la pertinencia de la ecografía realizada por los médicos de familia / Reasons for the relevance of ultrasound performed by doctors family

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Utility of high-frequency ultrasound: moving beyond the surface to detect changes in skin integrity.

Ultrasound imaging is a versatile modality frequently used in clinical medicine, most likely due to its low cost, low risk to patients, and the ability to provide images in real time. Ultrasound used typically in clinical settings has frequencies between 2 and 12 MHz. Lower frequencies produce greater resolution but are limited in depth penetration; higher frequencies produce greater resolution, but depth of penetration is limited. High-frequency ultrasound (HFUS) shows promise for detection of certain changes in the skin and this has implications for early detection of changes associated with pressure ulcer formation and wound healing. The purpose of this article was to provide an overview of where HFUS has been used with the skin and provide some discussion on its utility with detecting skin changes related to pressure.