<meta charset="utf8"></head><body>פרוטוקול POCUS להערכת IVC בניהול אי ספיקת לב

<ol>
	<li>Diaz-Gomez, J., Mayo, P. H., Koenig, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasonography.">Point-of-care ultrasonography.</a> N Engl J Med. 385, 1593-1602 (2021).</li><li>Zieleskiewicz, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bedside+POCUS+during+ward+emergencies+is+associated+with+improved+diagnosis+and+outcome:+An+observational,+prospective,+controlled+study.">Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: An observational, prospective, controlled study.</a> Crit Care. 25 (1), 34 (2021).</li><li>Al Deeb, M., Barbic, S., Featherstone, R., Dankoff, J., Barbic, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasonography+of+the+diagnosis+of+acute+cardiogenic+pulmonary+edema+in+patients+presenting+with+acute+dyspnea:+A+systematic+review+and+meta-analysis.">Point-of-care ultrasonography of the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: A systematic review and meta-analysis.</a> Acad Emerg Med. 21 (8), 843-852 (2014).</li><li>Spevack, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Serial+lung+and+IVC+ultrasound+in+the+assessment+of+congestive+heart+failure.">Serial lung and IVC ultrasound in the assessment of congestive heart failure.</a> Crit Ultrasound J. 9 (1), 7 (2017).</li><li>Ciozda, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+efficacy+of+sonographic+measurement+of+inferior+vena+cava+diameter+as+an+estimate+of+central+venous+pressure.">The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure.</a> Cardiovascular Ultrasound. 14 (1), 33 (2015).</li><li>Kedan, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Decreasing+hospital+utilization+of+a+high+risk+heart+failure+population+in+a+large+urban+Accountable+Care+Organization:+The+use+of+a+clinical+pharmacist,+serial+biomarkers,+and+Point+of+Care+Ultrasound.">Decreasing hospital utilization of a high risk heart failure population in a large urban Accountable Care Organization: The use of a clinical pharmacist, serial biomarkers, and Point of Care Ultrasound.</a> J Am Coll Cardiol. 67 (13 Supplement), 1298 (2016).</li><li>Kehl, D., Zimmer, R., Sudan, M., Kedan, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Handheld+ultrasound+as+a+novel+predictive+tool+in+atrial+fibrillation:+Prediction+of+outcomes+following+electrical+cardioversion.">Handheld ultrasound as a novel predictive tool in atrial fibrillation: Prediction of outcomes following electrical cardioversion.</a> JMIR Cardio. 2 (1), e7 (2018).</li><li>Miller, W. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluid+volume+homeostasis+in+heart+failure:+A+tale+of+2+circulations.">Fluid volume homeostasis in heart failure: A tale of 2 circulations.</a> J Am Heart Assoc. 11 (18), e026668 (2022).</li><li>Porter, T. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+use+of+echocardiography+as+a+monitor+for+therapeutic+intervention+in+adults:+A+report+from+the+American+Society+of+Echocardiography.">Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the American Society of Echocardiography.</a> J Am Soc Echocardiogr. 28 (1), 40-56 (2015).</li><li>Katz, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+search+of+euvolemia+in+heart+failure.">In search of euvolemia in heart failure.</a> J Am Cardiol HF. 2 (3), 306-307 (2014).</li><li>Bhoil, R., Ahluwalia, A., Chopra, R., Surya, M., Bhoil, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Signs+and+lines+in+lung+ultrasound.">Signs and lines in lung ultrasound.</a> J Ultrason. 21 (86), e225-e233 (2021).</li><li>Hacialiogullari, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+point-of-care+lung+and+inferior+vena+cava+ultrasound+in+clinical+decisions+for+patients+presenting+to+the+emergency+department+with+symptoms+of+acute+decompensated+heart+failure.">Role of point-of-care lung and inferior vena cava ultrasound in clinical decisions for patients presenting to the emergency department with symptoms of acute decompensated heart failure.</a> J Ultrasound Med. 40 (4), 751-761 (2021).</li><li>Gil-Rodriguez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+findings+of+lung+ultrasonography+in+COVID-19:+A+systematic+review.">Ultrasound findings of lung ultrasonography in COVID-19: A systematic review.</a> Eur J Radiol. 148, 110156 (2022).</li><li>Li, S. J., Lee, J., Hall, J., Sutherland, T. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+inferior+vena+cava:+Anatomical+variants+and+acquired+pathologies.">The inferior vena cava: Anatomical variants and acquired pathologies.</a> Insights into Imaging. 12 (1), 123 (2021).</li><li>Lam, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accelerated+remote+consultation+tele-POCUS+in+cardiopulmonary+assessment+(ARCTICA).">Accelerated remote consultation tele-POCUS in cardiopulmonary assessment (ARCTICA).</a> POCUS J. 5 (2), 55-58 (2020).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Aquasonic Ultrasound Gel 100</td>
			<td>Parker</td>
			<td>ECO #20-0299</td>
			<td>The company and the catalog number is one example</td>
		</tr>
		<tr>
			<td>Epic Electronic Health Record</td>
			<td>Epic</td>
			<td></td>
			<td>The company and the catalog number is one example</td>
		</tr>
		<tr>
			<td>GE Vscan Extend</td>
			<td>General Electric</td>
			<td>5721203-100 Rev.13</td>
			<td>Broad-bandwidth linear array: 3.3-8.0 MHz</td>
		</tr>
		<tr>
			<td>Haiku</td>
			<td>Epic</td>
			<td>10.3</td>
			<td>The company and the catalog number is one example</td>
		</tr>
	</tbody>
</table>

workflow and framework for collecting and implementing point-of-care ultrasound data in the management of heart failure patients 

Point-of-care ultrasound (POCUS) is an emerging technology that can be used in day-to-day clinical settings. Although commercially available hand-carried ultrasound devices have been marketed for over 13 years, regular use outside of bedside procedures has been limited1. POCUS offers an intuitive application in the acute care setting for the diagnosis of specific disease states like cardiac arrest, congestive heart failure, identification of pneumothorax, assessment of pericardial effusion, and detection of free intra-abdominal fluid in trauma or surgery patients2. POCUS is well established as an evidence-based tool in assessing patients for the diagnosis of heart failure3. However, the implementation of POCUS using serial assessment in response to therapy is less well-established4.
POCUS-guided heart failure management includes the visual assessment of central venous pressure (CVP) and right atrial pressure by observing the diameter and collapsibility of the inferior vena cava (IVC). Additionally, POCUS can be used to observe the presence of pleural effusions and anatomical changes that correlate with physiological changes during treatment, including biventricular cardiac function, heart rate, contractility, mitral valve regurgitation, and acute changes in clinical status not self-evident with physical examination5.
In 2011, the clinical practice group began incorporating POCUS into the routine physical examination for all face-to-face inpatient and outpatient encounters (approximately 40,000). Anecdotal observations of anatomical changes visualized by POCUS often seemed to correspond with clinical events and biomarker measurements6 (Figure 1).
In the study institution, beginning in 2015, a discrete data field was built within the electronic health record to track the diameter and compressibility of the inferior vena cava (IVC). A binary data field was also created to document the presence or absence of pleural effusions identified with POCUS. In over seven years of patient care with the incorporation of POCUS in the clinical management of hospitalized heart failure patients, the acquisition and incorporation of POCUS data and IVC measurements have been recorded for more than 6,000 encounters. From an experiential perspective, the clinical practice group found the use of POCUS valuable in assisting with optimizing medical management and refining guideline-directed medical therapy, thereby personalizing the care of heart failure patients.
In this study, a POCUS exam was conducted using a phased-array hand-carried ultrasound device with a digital display screen. Images of the inferior vena cava (IVC) were obtained by scanning the patient through the subcostal acoustic window7 (Figure 2). The IVC images were acquired and measured on the digital display, specifically at a level caudal to the middle hepatic vein. Live images were paused, and a frame-by-frame image scroll on the device was utilized to identify and measure the maximal IVC diameter during the cardiac and respiratory cycle. The measurement was recorded in a data flowsheet within the patient&#39;s electronic medical record, and a screenshot of the measured image was uploaded into the patient chart to document the location and angle of measurement acquisition. Subsequently, the measurement flowsheet and uploaded image were added to the patient&#39;s progress note.

<meta charset="utf8"></head><body>מחבר זרקור: זרימת עבודה לשילוב נתוני POCUS ב- EHR לניהול חולי אי ספיקת לב

זרימת עבודה ומסגרת לאיסוף ויישום נתוני אולטרסאונד נקודתי בניהול חולי אי ספיקת לב 

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 a comparative, prospective assessments of heart failure patients.It also offers a path for the development of a database of POCUS-treated heart failure patients.

Management and prevention of acute decompensated heart failure remain highly prevalent and challenging medical conditions. Incorporation of Point-of-Care ...

workflow-framework-for-collecting-implementing-point-care-ultrasound

Research

JoVE Journal

Medicine

Workflow and Framework for Collecting and Implementing Point-of-Care Ultrasound Data in the Management of Heart Failure Patients 

424 Views.  Smidt Heart Institute. עבודתנו נועדה להדגים זרימת עבודה לרכישה ושילוב של נתוני POCUS ברשומה הרפואית האלקטרונית לניהול חולים עם אי ספיקת לב. בכוונתנו לשתף את זרימות העבודה שלנו שפותחו ותוקננו, כתבנית לשילוב נתוני POCUS בניהול אי ספיקת לב. חלק מהאתגרים הניסיוניים הנוכחיים כוללים גיש...

Video: מחבר זרקור: זרימת עבודה לשילוב נתוני POCUS ב- EHR לניהול חולי אי ספיקת לב

Management and prevention of acute decompensated heart failure remain highly prevalent and challenging medical conditions. Incorporation of Point-of-Care Ultrasound (POCUS) as an adjunctive tool for assessing volume status and treatment response has shown significant promise. POCUS can be used for imaging internal anatomic structures serially and capturing these images for comparison and measurement over time. This protocol describes a scalable and standardized methodology for the serial assessment of the inferior vena cava (IVC). The methodology includes serial image collection, measurement, and presentation in the electronic medical record. A workflow for POCUS-acquired images of the IVC was created to capture the images and measure the diameter in a discrete data field for direct comparison over time and in response to clinical management. The protocol also includes the assessment of the presence or absence of pleural effusion as discrete data in the standardized workflow. By integrating POCUS into heart failure management, clinicians can improve patient outcomes through more precise and timely adjustments in treatment.

This protocol presents a scalable workflow for the use of point-of-care ultrasound in the management of hospitalized and outpatient heart failure patients.

Standardized Methodology for the Serial Assessment of the Inferior Vena Cava

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 prebuilt discrete data field within the electronic health record flowsheet.Include the prebuilt IVC measurement data field flowsheet 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 flowsheet. 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.