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Does the intravascular volume status in haemodialysis patients measured by inferior vena cava ultrasound correlate with bioimpedance spectroscopy?
J Clin Nurs. 2019 Jun; 28(11-12):2135-2146.JC

Abstract

AIMS AND OBJECTIVES

To evaluate the accuracy of traditional clinical predialytic fluid assessment by renal nurses and the efficacy of 2 additional fluid assessment methods focussing on the potential preventative effect for intradialytic hypotension (IDH).

BACKGROUND

Predialytic fluid assessment remains a daily challenge for renal nurses, when aiming for adverse event free haemodialysis treatments. Adding further objective parameters obtained through noninvasive methods into pre- and intradialytic fluid assessment could potentially improve health outcomes for haemodialysis patients.

DESIGN

Comparative, observational study of three fluid assessment methods on their reliability on volume status and correlation to clinical outcomes.

METHODS

Clinical predialytic nursing fluid assessments in 30 haemodialysis patients were compared with additional initial bioimpedance spectroscopy (BIS) measurements, and 3 serial intradialytic ultrasound scans of the inferior vena cava (IVC-US) performed by a second renal nurse concurrently during the same session. A retrospective data analysis compared all measurements in each individual for the predictive value for IDH. A STROBE checklist for observational cohort studies was used for the reporting of results.

RESULTS

Seven subjects experienced episodes of symptomatic intradialytic hypotension (S-IDH), which would have been anticipated by IVC-US or by BIS in 5 patients (71%). Using an algorithm to predict IDH would have provided a sensitivity of 100% and specificity of 95%.

CONCLUSION

Both additional fluid assessment methods would have provided critical information before and during each haemodialysis session. Therefore, we consider them as being potentially effective for the prevention of intradialytic hypotension, with IVC-US being similar to BIS.

RELEVANCE TO CLINICAL PRACTICE

Traditional clinical nursing fluid assessment methods in haemodialysis patients do not provide sufficient information to prevent episodes of IDH. Additional objective fluid assessment methods are useful and likely to lead to improved health outcomes in HD patients when applied by renal nurses. A combination of IVC-US, MAP and BIS has potential to reduce the risk of IDH events in HD patients significantly.

Authors+Show Affiliations

School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia.School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia.School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia.School of Medicine, Faculty of Health Sciences, Curtin University Perth, Perth, Western Australia, Australia.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)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

30667115

Citation

Steinwandel, Ulrich, et al. "Does the Intravascular Volume Status in Haemodialysis Patients Measured By Inferior Vena Cava Ultrasound Correlate With Bioimpedance Spectroscopy?" Journal of Clinical Nursing, vol. 28, no. 11-12, 2019, pp. 2135-2146.
Steinwandel U, Gibson N, Towell-Barnard A, et al. Does the intravascular volume status in haemodialysis patients measured by inferior vena cava ultrasound correlate with bioimpedance spectroscopy? J Clin Nurs. 2019;28(11-12):2135-2146.
Steinwandel, U., Gibson, N., Towell-Barnard, A., Parsons, R., Rippey, J., & Rosman, J. (2019). Does the intravascular volume status in haemodialysis patients measured by inferior vena cava ultrasound correlate with bioimpedance spectroscopy? Journal of Clinical Nursing, 28(11-12), 2135-2146. https://doi.org/10.1111/jocn.14804
Steinwandel U, et al. Does the Intravascular Volume Status in Haemodialysis Patients Measured By Inferior Vena Cava Ultrasound Correlate With Bioimpedance Spectroscopy. J Clin Nurs. 2019;28(11-12):2135-2146. PubMed PMID: 30667115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does the intravascular volume status in haemodialysis patients measured by inferior vena cava ultrasound correlate with bioimpedance spectroscopy? AU - Steinwandel,Ulrich, AU - Gibson,Nick, AU - Towell-Barnard,Amanda, AU - Parsons,Richard, AU - Rippey,James, AU - Rosman,Johan, Y1 - 2019/02/28/ PY - 2018/05/06/received PY - 2018/11/29/revised PY - 2019/01/14/accepted PY - 2019/1/23/pubmed PY - 2019/6/4/medline PY - 2019/1/23/entrez KW - assessment KW - blood Pressure KW - chronic kidney disease KW - clinical decision-making KW - clinical judgement KW - haemodialysis KW - intervention KW - nursing diagnosis KW - observation KW - renal nursing SP - 2135 EP - 2146 JF - Journal of clinical nursing JO - J Clin Nurs VL - 28 IS - 11-12 N2 - AIMS AND OBJECTIVES: To evaluate the accuracy of traditional clinical predialytic fluid assessment by renal nurses and the efficacy of 2 additional fluid assessment methods focussing on the potential preventative effect for intradialytic hypotension (IDH). BACKGROUND: Predialytic fluid assessment remains a daily challenge for renal nurses, when aiming for adverse event free haemodialysis treatments. Adding further objective parameters obtained through noninvasive methods into pre- and intradialytic fluid assessment could potentially improve health outcomes for haemodialysis patients. DESIGN: Comparative, observational study of three fluid assessment methods on their reliability on volume status and correlation to clinical outcomes. METHODS: Clinical predialytic nursing fluid assessments in 30 haemodialysis patients were compared with additional initial bioimpedance spectroscopy (BIS) measurements, and 3 serial intradialytic ultrasound scans of the inferior vena cava (IVC-US) performed by a second renal nurse concurrently during the same session. A retrospective data analysis compared all measurements in each individual for the predictive value for IDH. A STROBE checklist for observational cohort studies was used for the reporting of results. RESULTS: Seven subjects experienced episodes of symptomatic intradialytic hypotension (S-IDH), which would have been anticipated by IVC-US or by BIS in 5 patients (71%). Using an algorithm to predict IDH would have provided a sensitivity of 100% and specificity of 95%. CONCLUSION: Both additional fluid assessment methods would have provided critical information before and during each haemodialysis session. Therefore, we consider them as being potentially effective for the prevention of intradialytic hypotension, with IVC-US being similar to BIS. RELEVANCE TO CLINICAL PRACTICE: Traditional clinical nursing fluid assessment methods in haemodialysis patients do not provide sufficient information to prevent episodes of IDH. Additional objective fluid assessment methods are useful and likely to lead to improved health outcomes in HD patients when applied by renal nurses. A combination of IVC-US, MAP and BIS has potential to reduce the risk of IDH events in HD patients significantly. SN - 1365-2702 UR - https://www.unboundmedicine.com/medline/citation/30667115/Does_the_intravascular_volume_status_in_haemodialysis_patients_measured_by_inferior_vena_cava_ultrasound_correlate_with_bioimpedance_spectroscopy L2 - https://doi.org/10.1111/jocn.14804 DB - PRIME DP - Unbound Medicine ER -