title: Feasibility and reliability of pocket-size ultrasound examinations of the pleural cavities and vena cava inferior performed by nurses in an outpatient heart failure clinic.
abstract: BACKGROUND
  Routine assessment of volume state by ultrasound may improve follow-up of heart failure patients.
  
  
  OBJECTIVE
  We aimed to study the feasibility and reliability of focused pocket-size ultrasound examinations of the pleural cavities and the inferior vena cava performed by nurses to assess volume state at an outpatient heart failure clinic.
  
  
  METHODS
  Ultrasound examinations were performed in 62 included heart failure patients by specialized nurses with a pocket-size imaging device (PSID). Patients were then re-examined by a cardiologist with a high-end scanner for reference within 1 h. Specialized nurses were able to obtain and interpret images from both pleural cavities and the inferior vena cava and estimate the volume status in all patients.
  
  
  RESULTS
  Time consumption for focused ultrasound examination was median 5 min. In total 26 patients had any kind of pleural effusion (in 39 pleural cavities) by reference. The sensitivity, specificity, positive and negative predictive values were high, all ≥ 92%. The correlations with reference were high for all measurements, all r ≥ 0.79. Coefficients of variation for end-expiratory dimension of inferior vena cava and quantification of pleural effusion were 10.8% and 12.7%, respectively.
  
  
  CONCLUSIONS
  Specialized nurses were, after a dedicated training protocol, able to obtain reliable recordings of both pleural cavities and the inferior vena cava by PSID and interpret the images in a reliable way. Implementing focused ultrasound examinations to assess volume status by nurses in an outpatient heart failure clinic may improve diagnostics, and thus improve therapy.
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Norway MI Lab, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway havard.dalen@ntnu.no.
authors.forename: Havard
authors.initials: H
authors.lastname: Dalen
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Norway.
authors.forename: Guri H
authors.initials: GH
authors.lastname: Gundersen
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Norway.
authors.forename: Kyrre
authors.initials: K
authors.lastname: Skjetne
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Norway.
authors.forename: Hilde H
authors.initials: HH
authors.lastname: Haug
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Norway.
authors.forename: Jens O
authors.initials: JO
authors.lastname: Kleinau
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway.
authors.forename: Tone M
authors.initials: TM
authors.lastname: Norekval
authors.affiliation: Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Norway.
authors.forename: Torbjorn
authors.initials: T
authors.lastname: Graven
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D002300:Cardiac Care Facilities; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000451:nursing*; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D035422:Pleural Cavity / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000295:instrumentation*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
keywords: Echocardiography; Vscan; diagnosis; hand-held; portable; scanner