Portable ultrasound brings help for heart failure patients
Specially trained nurses are able to dispense medication for heart patients more precisely using a pocket-sized ultrasound device.
POCKET ULTRASOUND:Early detection of fluid retention in patients is important in preventing their heart failure from getting worse.
Nurses who are trained in the use of handheld pocket ultrasound devices can dispense diuretic drugs more precisely. These medications prevent harmful fluid retention in patients with heart failure.
Pocket ultrasounds can help trained nurses determine the right medication. Photo: Nils Heldal UNIKARD
Last year researchers at Levanger Hospital and NTNU published a study showing that cardiac nurses who have learned to use pocket ultrasound devices can accurately calculate fluid retention both in the pleural cavities (between the two membranes surrounding the lungs) and the inferior vena cava of heart failure patients.
Diuretics are best treatment
Diuretic medications are the best treatment for fluid retention. Researchers have now found that determining how much fluid has accumulated in heart failure patients with the use of pocket ultrasound technology can be clinically important in treatment.
According to Guri Holmen Gundersen, who is an academic and research nurse and the first author of the study, researchers found that a relatively high proportion of patients who came in for monitoring at the heart failure clinic had pleural effusion, sometimes referred to as “water in the lungs.” “In addition,” she says, “we found that the ultrasound examination significantly predicted diuretic dosing compared to other routine examinations and blood tests.”
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Ultrasound changed treatment in 30 of 119 cases
The study is based on the surveys of 62 patients who visited the heart failure outpatient clinic at Levanger Hospital on a total of 119 occasions.
The researchers examined 62 patients who visited the heart failure outpatient clinic at Levanger Hospital. Illustration: Thinkstock
Two specialized nurses examined them each time, one using a pocket ultrasound and one not using the device. Following the exam, each nurse and cardiologist team discussed adjustments to the patient treatment plan.
In 89 of the paired consultations between the nurse and the cardiologist, the two teams (with and without ultrasound) agreed regarding diuretic dosing, meaning the ultrasound examination changed the treatment in 30 of 119 cases.
“Using a pocket ultrasound device enables health personnel to detect signs of dehydration or worsening heart failure early, before the patient experiences symptoms of breathlessness, weight gain and oedema. Proper diuretic dose adjustment can quickly improve the condition and prevent episodes of acute exacerbation of the disease that would require hospitalization,” says Gundersen.
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Fluid buildup is common
In the study, pleural effusion was found in 42% of the patients, which shows that this is a common problem in heart failure.
Using the handheld ultrasounds to measure the volume of fluid retention was the single factor with the greatest impact on the dosage amounts prescribed for patients and on any dosage changes in follow-up visits.
More aggressive treatment of fluid retention in patients can restore fluid balance and potentially improve the prognosis of patients.
Researchers see promise in these study findings, but stress that it remains to be seen whether the effects of adjusting the medication dosage will have clinical significance for patient progress in the longer term.l.
Reference: Gundersen, G. H., Norekval, T. M., Haug, H. H., Skjetne, K., Kleinau, J. O., Graven, T., & Dalen, H. (2015). Adding, point of care ultrasound to assess volume status in heart failure patients in a nurse-led outpatient clinic. A randomised study. Heart, heartjnl-2015.
