Focused ultrasound of the pleural cavities and the pericardium by nurses after cardiac surgery

Abstract

Objectives. We aimed to study the feasibility and reliability of focused ultrasound (US) examinations to quantify pericardial (PE)- and pleural effusion (PLE) by a pocket-size imaging device (PSID) performed by nurses in patients early after cardiac surgery. Design. After a 3-month training period, with cardiologists as supervisors, two nurses examined 59 patients (20 women) with US using a PSID at a median of 5 days after cardiac surgery. The amount of PE and PLE was classified in four categories by US (both) and chest x-ray (PLE only). Echocardiography, including US of the pleural cavities, by experienced cardiologists was used as reference. Results. Focused US by the nurses was more sensitive than x-ray to detect PLE. The correlations of the quantification of PE and PLE by the nurses and reference was r (95% confidence interval) 0.76 (0.46–0.89) and 0.81 (0.73–0.89), both p < 0.001. PE and PLE were drained in one and six (eight cavities) patients, all classified as large amount by the nurses. Conclusions. Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused US and outperform the commonly used chest x-ray regarding PLE after cardiac surgery.

Patient-reported outcomes and associations with pleural effusion in outpatients with heart failure: an observational cohort study

“…20 Point-of-care ultrasound of the pleural cavities is a sensitive and specific test for detection of PLE, 1 21 and is previously shown to be superior to chest X-ray for diagnostics of PLE. 22 The current study indicates that caring for improvement of patient-reported outcomes is an additional reason for systematic use of ultrasound to assess PLE in patients with HF, 21 as excessive volume status could be an explanation for the poor QoL. However, if the availability of ultrasound is limited, a MLHFQ-score >40 identifies ∼80% of those with moderate to severe PLE and these should be referred to ultrasound.…”

A systematic review of pocket-sized imaging devices: small and mighty?

“…The 25 selected studies were published between 2009 and 2017. Fourteen studies were European ( 9 , 10 , 11 , 12 , 13 , 14 , 15 ) (seven from Norway ( 16 , 17 , 18 , 19 , 20 , 21 , 22 )), five from Japan ( 23 , 24 , 25 , 26 , 27 ), five from USA ( 28 , 29 , 30 , 31 , 32 ) and one from India ( 33 ). We considered the findings in three groups: (1) scans performed by experienced users ( n = 16); (2) scans performed by non-expert physicians, with little or no prior experience ( n = 7); (3) scans performed by nurses with variable experience ( n = 2).…”

Point‐of‐care ultrasound with pocket‐size devices in emergency department

“…Different applications of pocket-size devices have been recently introduced, particularly in the setting of ED and critical care units. [9][10][11][12][13] In outpatients setting the use of pocket-size devices have demonstrated its usefulness when used by doctors, nurses, and medical students. 14 In low resources settings, the use of small devices is time saving and has demonstrated its clinical applications and impact on patients' management.…”

“…The ability of combining small size with high‐resolution imaging has led to a widespread use of small apparatus. Different applications of pocket‐size devices have been recently introduced, particularly in the setting of ED and critical care units . In outpatients setting the use of pocket‐size devices have demonstrated its usefulness when used by doctors, nurses, and medical students .…”