Using Bedside Ultrasound For Fluid Assessment and Responsiveness

Bedside ultrasound is a tool being increasingly used among clinicians. Technological advancements of ultrasound systems have made them smaller and more portable with increased image resolution, making bedside ultrasound an available and affordable tool in the intensive care unit. However, acceptance of this technology has been slowly accepted. Multiple studies have indicated that bedside ultrasound assessments can be successfully used, even if clinician training has been limited. Hemodynamic instability is a common occurrence in intensive care settings. Accurate assessment of fluid status can be difficult to achieve. A common method to treat hypotension is by intravenous administration of isotonic crystalloid. However, complications of fluid overload can also lead to deleterious outcomes. Ultrasound can be used to assess the inferior vena cava for fluid status. Further, there are some studies that have shown promise that inferior vena cava measurements can also help indicate fluid responsiveness. The purpose of this project is to write a manuscript directed toward bedside clinicians demonstrating the current evidence of evaluating the inferior vena cava using bedside ultrasound in the hemodynamically unstable patient. In this manuscript, recommendations will also be provided to help the clinician determine fluid status and responsiveness. The final version of the manuscript will be submitted to the American Journal of Critical Care. The curricular elements and competencies required in doctoral education for advanced nurse practice, the DNP essentials, were utilized in the formation and execution of this project. The essentials utilized include: a) essential I, scientific underpinnings for practice, b) essential III, clinical scholarship and analytical methods of evidence based practice, c) essential IV, patient care technology for improvement and transformation of health care, d) essential VI, interpersonal collaboration for improving patient and population health outcomes, e) essential VII, clinical prevention and population health for improving the nation's health and f) essential VIII, advanced nursing practice