Due to the severity of their disease, palliative care patients often present
complex clinical symptoms and complaints like pain, shortness of breath, nausea,
loss of appetite, and fatigue. Solely relying on the information available from
the history and physical examination often causes uncertainty among palliative
care physicians regarding treatment decisions during home visits, potentially
leading to unnecessary hospitalizations or transfer to cross-sectional imaging
in radiological practices. A rational approach is essential to avoid diagnostic
aggressiveness while still providing the imaging information required for
optimal palliative care. Bedside use of handheld ultrasound (HHUS) has the
potential to expand the diagnostic and therapeutic spectrum in the case of
symptom exacerbation but is still underutilized. In this review, we evaluate the
potential uses of HHUS in home care settings to provide a more accurate
diagnosis of the most common symptoms in palliative patients and to guide
bedside interventions such as bladder catheterization, thoracentesis,
paracentesis, venous access, and regional anesthesia. Specific training programs
for ultrasound in palliative care are currently not available. Adequate
documentation is warranted but fraught with technological and privacy issues.
Expert supervision and quality assurance are necessary. Despite its limitation
and challenges, we suggest that HHUS leads to improved clinical decision-making,
expedited symptom relief, and reduced complications without burdening of the
patient and costly transfer to hospital or specialty consultations.
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