Our work is intended to demonstrate a workflow for acquiring and integrating POCUS data into the electronic health record for the management of patients with heart failure. We intend to share our workflows that have been developed and standardized as a template for incorporating POCUS data in heart failure management. Some of the current experimental challenges include access to low cost POCUS devices, different user expertise, the limited availability of expert instruction, and the limited number of easily incorporated POCUS workflows for implementation in clinical care settings.
Our protocol demonstrates a workflow for integrating real-time POCUS data into the live electronic patient record. This includes images and measurements that can be compared and observed for an individual patient, reflecting physiological changes with the treatment and the response to heart failure. This workflow allows for comparative prospective assessments of heart failure patients.
It also offers a path for the development of a database of POCUS treated heart failure patients. To begin, position the patient appropriately to expose the area of interest. Ensure the ultrasound machine is set up and calibrated correctly for the type of scan needed.
Choose the appropriate ultrasound probe based on the depth and type of tissue being imaged. Adjust the frequency and depth settings on the ultrasound machine to optimize image resolution. Position the patient on their back for optimal POCUS image acquisition.
Apply a sufficient amount of ultrasound gel to the skin surface to ensure good acoustic coupling and reduce air between the probe and the skin. Use a phased array ultrasound probe to obtain IVC measurements at the level coddle to the insertion of the hepatic vein. Capture the IVC image with measurements displayed, including the anatomy and beam depth gauge on the image display screen.
Record the IVC measurement into a pre-built discrete data field within the electronic health record flow sheet. Include the pre-built IVC measurement data field flow sheet within the electronic health record and attach screen captured images to the patient progress note. Position the patient upright or in the lateral decubitus posture, alternating between the right and left sides serially.
Utilize a two to five megahertz phased array probe to scan for echo-free space inferior to the lung pleural border, and superior to the ipsilateral diaphragm during scanning. Document yes for the presence of pleural effusion identified by increased echo-free space in the ipsilateral pleural space, or no for the absence of pleural effusion. Enter the response into the corresponding cell in the electronic health record flow sheet.
After completing the scan, clean the ultrasound probe and machine, then dispose of the used ultrasound gel appropriately. Identify actionable findings that influence clinical care decision-making on a patient by patient basis. Identify IVC images consistent with physiology associated with elevated or reduced central venous pressure.
