Utilization of Point-of-Care Ultrasound in a Specialist Palliative Care Team Across Multiple Care Settings: A Retrospective Chart Review

Abstract

Background: Technological advancements have rapidly increased the use of point-of-care ultrasound (POCUS) across various medical disciplines, leading to real-time information for clinicians at the bed side. However, literature reveals scant evidence of POCUS use in palliative care. The objective of this study was to examine the use of POCUS in a specialist palliative care setting. Methods: A retrospective chart review was conducted from January 2018 to June 2019 in Brampton, Canada, to evaluate characteristics of patients for whom POCUS was utilized. Patients were identified through pre-existing logs and descriptive information was collected from electronic health records, including demographic information, life-limiting diagnosis, patient assessment location, diagnosis made with POCUS, and, if applicable, volume of fluid drained. Results: We identified 126 uses of POCUS in 89 unique patients. Sixty-two patients (69.7%) had a cancer diagnosis, with patients most commonly suffering from gastrointestinal, lung, and breast pathologies. Sixty-one POCUS cases (48.4%) were in the outpatient setting. Eighty-one POCUS cases (64.3%) revealed a diagnosis of ascites and 21 POCUS cases (16.7%) revealed a diagnosis of pleural effusion. Other diagnoses made with POCUS included bowel obstruction, pneumonia, and congestive heart failure. During the study period, 52 paracentesis and 7 thoracentesis procedures were performed using POCUS guidance. Conclusion: We identified multiple indications in our specialist palliative care setting where POCUS aided in diagnosis/management of patients in both inpatient and outpatient settings. Further studies can be conducted to identify the potential benefits in symptom burden, patient and caregiver satisfaction, and health care utilization in palliative care patients receiving POCUS.

Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine

“…This expedites the implementation of appropriate treatment, such as antibiotic therapy or supportive measures aimed at enhancing symptom management. It is important to note that these therapeutic decisions are tailored to each patient, prioritizing their comfort and overall quality of life [ 52 ].…”

Manejo Da Dor

“…O POCUS pode ser utilizado para avaliação da obstrução ureteral, que pode ser causada por compressão externa (aumento dos linfonodos, tumores retroperitoneais ou pélvicos) ou bloqueio interno (nefrolitíase, tumor urotelial). Além disso, a ultrassonografia da bexiga à beira do leito pode estimar com precisão o volume e o fluxo da bexiga, permitindo um diagnóstico rápido da retenção urinária (ARYA A, et al, 2022).…”

“…Quando a toracocentese é indicada, a orientação por ultrassonografia tem demonstrado vantagens sobre a abordagem convencional que se baseia em sinais clínicos e a radiografia de tórax na avaliação de derrames pleurais. Isso permite a identificação do local mais adequado para a inserção do cateter, contribuindo, assim, para a redução das complicações pós-intervenção, como o pneumotórax (ARYA A, et al, 2022).…”