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Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study.
Hemodial Int. 2018 04; 22(2):261-269.HI

Abstract

INTRODUCTION

Ultrasound of the inferior vena cava (IVC-US) has been used to estimate intravascular volume status and fluid removal during a hemodialysis session. Usually, renal nurses rely on other, imprecise methods to determine ultrafiltration. To date, no study has examined whether renal nurses can reliably perform ultrasound for volume assessment and for potential prevention of intradialytic hypotension. This pilot study aimed to determine if a renal nurse could master the skill of performing and correctly interpreting Point of Care Ultrasound on patients receiving hemodialysis.

METHODS

After receiving theoretical training and performing 100 training scans, a renal nurse performed 60 ultrasound scans on 10 patients. These were categorized by the nurse into hypovolemic, euvolemic, or hypervolemic through measurement of the maximal diameter and degree of collapse of the IVC. Scans were subsequently assessed for adequacy and quality by two sonologists, who were blinded to each other's and the nurse's results.

FINDINGS

The interrater reliability of 60 scans was good, with intraclass correlation 0.79 (95% confidence interval (CI) =0.63-0.87) and with a good interrater agreement for the following estimation of intravascular volume (Cohen's weighted Kappa κw = 0.62), when comparing the nurse to an expert sonographer.

DISCUSSION

A renal nurse can reliably perform ultrasound of the IVC in hemodialysis patients, obtaining high quality scans for volume assessment of hemodialysis patients. This novel approach could be more routinely applied by other renal nurses to obtain objective measures of patient volume status in the dialysis setting.

Authors+Show Affiliations

School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.School of Medicine, Faculty of Health Sciences, Curtin University Perth, Perth, Western Australia, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29024379

Citation

Steinwandel, Ulrich, et al. "Can a Renal Nurse Assess Fluid Status Using Ultrasound On the Inferior Vena Cava? a Cross-sectional Interrater Study." Hemodialysis International. International Symposium On Home Hemodialysis, vol. 22, no. 2, 2018, pp. 261-269.
Steinwandel U, Gibson N, Towell A, et al. Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study. Hemodial Int. 2018;22(2):261-269.
Steinwandel, U., Gibson, N., Towell, A., Rippey, J. J. R., & Rosman, J. (2018). Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study. Hemodialysis International. International Symposium On Home Hemodialysis, 22(2), 261-269. https://doi.org/10.1111/hdi.12606
Steinwandel U, et al. Can a Renal Nurse Assess Fluid Status Using Ultrasound On the Inferior Vena Cava? a Cross-sectional Interrater Study. Hemodial Int. 2018;22(2):261-269. PubMed PMID: 29024379.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study. AU - Steinwandel,Ulrich, AU - Gibson,Nicholas, AU - Towell,Amanda, AU - Rippey,James J R, AU - Rosman,Johan, Y1 - 2017/10/11/ PY - 2017/10/13/pubmed PY - 2019/3/5/medline PY - 2017/10/13/entrez KW - Hemodialysis KW - inferior vena cava KW - intravascular volume status KW - point of care ultrasound KW - renal nurses SP - 261 EP - 269 JF - Hemodialysis international. International Symposium on Home Hemodialysis JO - Hemodial Int VL - 22 IS - 2 N2 - INTRODUCTION: Ultrasound of the inferior vena cava (IVC-US) has been used to estimate intravascular volume status and fluid removal during a hemodialysis session. Usually, renal nurses rely on other, imprecise methods to determine ultrafiltration. To date, no study has examined whether renal nurses can reliably perform ultrasound for volume assessment and for potential prevention of intradialytic hypotension. This pilot study aimed to determine if a renal nurse could master the skill of performing and correctly interpreting Point of Care Ultrasound on patients receiving hemodialysis. METHODS: After receiving theoretical training and performing 100 training scans, a renal nurse performed 60 ultrasound scans on 10 patients. These were categorized by the nurse into hypovolemic, euvolemic, or hypervolemic through measurement of the maximal diameter and degree of collapse of the IVC. Scans were subsequently assessed for adequacy and quality by two sonologists, who were blinded to each other's and the nurse's results. FINDINGS: The interrater reliability of 60 scans was good, with intraclass correlation 0.79 (95% confidence interval (CI) =0.63-0.87) and with a good interrater agreement for the following estimation of intravascular volume (Cohen's weighted Kappa κw = 0.62), when comparing the nurse to an expert sonographer. DISCUSSION: A renal nurse can reliably perform ultrasound of the IVC in hemodialysis patients, obtaining high quality scans for volume assessment of hemodialysis patients. This novel approach could be more routinely applied by other renal nurses to obtain objective measures of patient volume status in the dialysis setting. SN - 1542-4758 UR - https://www.unboundmedicine.com/medline/citation/29024379/Can_a_renal_nurse_assess_fluid_status_using_ultrasound_on_the_inferior_vena_cava_A_cross_sectional_interrater_study_ L2 - https://doi.org/10.1111/hdi.12606 DB - PRIME DP - Unbound Medicine ER -