Point-of-care examinations using handheld ultrasound devices performed by intensive care nurses in a cardiac intensive care unit

Abstract

Aims: Having nurses to perform point-of-care ultrasound (POCUS) when physically examining patients to assess for early signs of decompensation and fluid overload has been proven to be feasible, provide extra information, and improve quality of care. To date, few studies have analyzed whether it is feasible for intensive care nurses to perform POCUS on critically ill patients. This study aimed to evaluate whether the findings of briefly trained intensive care nurses' ultrasound examinations agreed with conventional examinations performed by physicians.

Methods and results: This comparative cross-sectional inter-rater agreement study comprised 50 patients admitted to a cardiac intensive care unit (CICU), with signs and symptoms of acute dyspnoea and suspected cardiac disease. After a brief training session, the study nurses performed standardized examinations of each patient's inferior vena cava (IVC) and the pleural and pericardial cavities using a handheld ultrasound device. A blinded physician repeated the same examinations using conventional ultrasound. Analysis using Gwet's agreement coefficient with quadratic weights showed moderate agreement for the IVC respiration variation [0.60; 95% confidence interval (CI): 0.38-0.82], and substantial agreement for the IVC diameter (0.70; 95% CI: 0.50-0.90) and right-sided pleural effusion (0.70; 95% CI: 0.52-0.88). For left-sided pleural effusion (0.85; 95% CI: 0.75-0.95) and pericardial effusion (0.95; 95% CI: 0.90-1.01), the agreement was almost perfect.

Conclusions: Briefly trained intensive care nurses in a CICU can perform POCUS examinations of the IVC and pleural and pericardial cavities with moderate to almost perfect agreement with identical examinations performed by physicians.

Keywords: Cardiac disorders; Focused ultrasound; Handheld ultrasound device; Nurse; Point-of-care ultrasound.