Abstract: FR-OR006

Point of Care Echocardiography and Ultrasound-Guided Volume Assessment Training for Nephrologists and Trainees to Teach Point of Care ECHO Skills

Session Information

Category: Nephrology Education

  • 1301 Educational Research

Authors

  • Karakala, Nithin, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Hobby, Gerren, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Bulloch, Kelly W., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Kakkera, Krishna siva sai, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Huggins, John Terrill, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Background

Intravascular volume assessment is an extremely important in the care of patients with acute kidney injury (AKI), chronic kidney disease, and patients needing intermittent and continuous renal replacement therapy. The current volume assessment tools like, MAP, heart rate, clinical examination are unreliable in assessing intravascular (IV) volume. The accuracy of invasive methods like central venous pressure, and pulmonary artery pressure measurements in assessing responsive to volume have been questioned in recent years. Nephrologists play a pivotal role in volume assessment and management. Point of care (echocardiogram) ECHO is a very valuable non-invasive tool for volume assessment.

Methods

During an intense 8 hour workshop, participants were trained by an experienced intensivist and a trained nephrologist. There were 2 stations which utilized live standardized patients and a preceptor. Station 1 covered basics of ECHO, cardiac para-sternal short and long axis views, and measurement of Inferior VenaCava (IVC) diameter and variability; second 2 station was cardiac apical 4 and 5 chamber views and lung parenchymal exam. The preceptors initially demonstrated the techniques, and then the participants were allowed to practice under supervision. We conducted a 20 multiple choice question (5 basics of ECHO, 9 cardiac ECHO, and 6 IVC and lung parenchymal volume assessment) per and post-test. There were 5 five-scale questions assessing procedural confidence.

Results

Twenty two participants (5 nephrologists, 16 trainees) attended and completed the test. There was a significant improvement in mean percentage of correct answers for the post compared to pre-test 78% (SD:17) vs 46% (SD:11); p<0.0001. The improvement during post compared to pre-test was observed in all 3 categories: basics of ECHO (79%, SD:22 vs 53%, SD:21; p<.001), cardiac ECHO (77%: 19 vs 40%: 19; p<0.0001) and IVC and lung (77%: 12 vs 46: 28; p<0.001). After attending the workshop the participants answered that they were either confident or extremely confident in acquiring or interpreting basic images 62% (SD: 17) vas 4% (SD:8) pre workshop.

Conclusion

Point of care ECHO training can help nephrologists learn and improve bedside volume assessment skill and reignite passion for nephrology among residents.

Funding

  • Clinical Revenue Support