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    Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study

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    Authors
    Steinwandel, U.
    Gibson, N.
    Towell, A.
    Rippey, J.
    Rosman, Johan
    Date
    2018
    Type
    Journal Article
    
    Metadata
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    Citation
    Steinwandel, U. and Gibson, N. and Towell, A. and Rippey, J. and Rosman, J. 2018. Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study. Hemodialysis International. 22 (2): pp. 261-269.
    Source Title
    Hemodialysis International
    DOI
    10.1111/hdi.12606
    ISSN
    1492-7535
    School
    Curtin Medical School
    URI
    http://hdl.handle.net/20.500.11937/73812
    Collection
    • Curtin Research Publications
    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 ?w = 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.

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