ROLE OF ULTRASOUND NURSE IN CRITICAL CARE

Presenter : Jyothis George NIS JPNATC

Moderator : Dr. Deepak Aggarwal

Ultrasonography has evolved to become one of the most versatile modalities for diagnosing and guiding treatment of critically ill patients.

INTRODUCTION

This modality is likely useful in resource challenged countries as it is non-invasive, economical, repeatable and can be performed at the bedside

Point of care

ULTRASOUND-HEAD

• Detecting any breakage in scalp, bone injury

• To see the MLS or hematoma in post operative decompressive craniotomy patients

CT view USG view

ULTRASOUND-HEAD

eyes

• used in head injury patients

• To detect size, reaction of patients whose eye examination not possible

• To detect ONSD –indicator of raised ICP

Orbital ultrasound

RACOON EYES USG VIEWED EYE

OPTIC NERVE SHEATH DIAMETER

• Increased ONSD correlates with increased ICP

• Upper limit of normal ONSD vary with age…– Adults: < 5 mm– Children > 1 Y: < 4.5 mm– Children < 1 Y < 4 mm

• ONSD 5 – 5.7 mm: may indicate ICP > 20 mmHg, especially if symptomatic– > 5 mm is 100% sensitive for elevated

ICP– All patients with elevated ICP have

ONSD > 5mm

NECK- ULTRASOUND

• In intubated patients the position of ET tube ,TT tube can be confirmed.

• Assist in procedures like percutaneous tracheostomy, CVP line insertion.

Neck-airway

Central vein insertion

Lung- ultrasound

• Lung movement, diaphragm, pleura• pneumothorax(absent/diminished lung movement),• hemothorax(presence of fluid), position of chest tube• Early detection of plural effusion(multiple B-lines) and

pulmonary edema than x-ray

Lung ultrasound

M- mode—LUNG SCAN

BARCODE SIGN SEASHORE SIGN

HEMOTHORAX

Cardiac &hemodynamics

• Volume status- indirect measurement of CVP by detecting IVC diameter

IVC Longitudinal – USG view

USG Finding- Normovolemia

USG FINGINGS… hypovolemia

USG FINDINGS… HYPERVOLEMIA

Abdomen and pelvis

• Presence of fluid in abdomen

• Urinary retention and amound of urine in bladder

vascular

• Vascular– Diagnosing deep venous thrombosis

THERAPEUTIC

Pericardiocentesis

Bedside Percutaneous nephrostomy

Guided arterial and central or peripheral vascular access 

For guided thoracocentesis and abdominal paracentesis

Guided drainage of collections

others

detecting fractures and foreign bodies

NURSING ROLE

Ultrasonography is rapid ,easy and repeatable

procedure

USG can be used as an alternative non invasive method to other various invasive procedures

So early detection of any abnormal condition is possible by a bed side ultrasound nurse, can be helpful in the management of critically ill patient.