Evaluating the Effect of Nursing-Performed Point-of-Care Ultrasound on Septic Emergency Department Patients.
| Autor: | Kalam S; Emergency Medicine, Loma Linda University Medical Center, Loma Linda, USA., Selden N; Emergency Medicine, Sutter Medical Center, Sacramento, USA., Haycock K; Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, USA., Lowe T; Nursing, Riverside University Health System Medical Center, Moreno Valley, USA., Skaggs H; Nursing, Riverside University Health System Medical Center, Moreno Valley, USA., Dinh VA; Emergency Medicine, Loma Linda University Medical Center, Loma Linda, USA.; Internal Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2023 Jun 16; Vol. 15 (6), pp. e40519. Date of Electronic Publication: 2023 Jun 16 (Print Publication: 2023). |
| DOI: | 10.7759/cureus.40519 |
| Abstrakt: | Introduction Nursing-performed point-of-care ultrasound (NP-POCUS) studies have been performed on applications such as ultrasound-guided peripheral intravenous line placement and assessing bladder volume. However, research on the use of NP-POCUS in the management of septic patients remains limited. The purpose of this quality improvement study was to investigate how NP-POCUS could impact fluid treatment decisions affecting septic patients in the emergency department (ED) using a focused IVC and lung ultrasound protocol. Methods Nurses received standardized training in POCUS and performed inferior vena cava (IVC) and lung ultrasound scans on septic patients in the ED at predetermined intervals (hours: zero, three, and six). Based on their findings, they were asked to make recommendations on fluid management. Emergency physicians (EPs), both residents and attendings, are providing recommendations for fluid management without the use of ultrasound, which is being compared to the nurse-driven POCUS assessment of fluid management. EPs reviewed the NP-POCUS assessments of patient fluid status to determine nursing accuracy. Results A total of 104 patients were scanned, with a mean age of 60.7 years. EPs agreed with nursing ultrasound assessments in 99.1% of cases. Nursing ultrasound images changed management or increased physician confidence in current treatment plans 83.7% and 96.6% of the time, respectively. Before reviewing saved nursing ultrasound images, EPs underestimated fluid tolerance in 37.5% of cases, overestimated fluid tolerance in 26% of cases, and correctly estimated fluid tolerance (within 500 ml) in 36.5% of cases. Throughout resuscitation, IVCs became less collapsible, the number of cases with B-lines was essentially unchanged, and less fluid was recommended. Conclusion This study demonstrated that nurse-performed POCUS is feasible and may have a meaningful impact on how physicians manage septic patients in the emergency department. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Kalam et al.) |
| Databáze: | MEDLINE |
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