Use Of Point-of-care Ultrasound Research Articles

POCUS increases successful placement of peripheral arterial lines in neonates by less experienced providers.

To assess success of peripheral arterial line (PAL) placement after implementing a point-of-care ultrasound (POCUS) program in a neonatal intensive care unit. This was a retrospective chart review of infants who underwent successful PAL placement from January 2019 to March 2021. Outcomes included first-attempt success and the number of attempts with and without the use of POCUS. Among 80 PALs, 36% were POCUS-guided. All POCUS-guided lines were placed by providers with < 5years neonatology experience. Among infants ≥ 2.5kg, the use of POCUS was associated with fewer attempts compared to non-POCUS PAL placement (1 vs. 2, p = 0.035). Conclusions: Use of POCUS for PAL placement was associated with fewer attempts for successful placement in infants ≥ 2.5kg by providers with less neonatology experience compared with traditional method. What is Known: • Arterial line placement in neonates has been traditionally done by palpation and can be technically challenging. • POCUS is an emerging tool in the NICU with increasing number of less clinically experienced providers in the NICU having access to ultrasound. What is New: • Use of POCUS by less experienced clinicians for arterial line placement resulted in fewer attempts compared to the traditional landmark-based approach in a cohort of neonates.

Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users.

Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.

Point-of-Care Ultrasonography for the Assessment of Dehydration in Children: A Systematic Review.

Accurate estimation of the degree of dehydration remains a diagnostic challenge. The primary objective was to systematically review the literature on the role of ultrasound in assessment of the degree of dehydration in children. Data sources included Ovid MEDLINE, Web of Science Core Collection, Current Index to Nursing and Allied Health Literature, Cochrane Library, ClinicalTrials.gov , and Trip Pro Database. Two independent reviewers used screening protocol to include articles on assessment of dehydration in children with the use of point-of-care ultrasonography (POCUS). The level of evidence was assessed in accordance with the "The Oxford 2011 Levels of Evidence." The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate risk of bias. We identified 108 studies, and 8 studies met our inclusion criteria. All studies were prospective cohort studies (level of evidence, 3-4). The authors of 5 studies used difference between ill weight and weight after rehydration as the reference standard for dehydration, and the authors of 3 studies used clinical dehydration scale. Two studies from the United States showed acceptable areas under the curve for inferior vena cava to aorta (IVC/Ao) diameter ratio at 0.72 and 0.73 for prediction of significant dehydration (>5% weight loss). The IVC/Ao ratio with cut-off at 0.8 had sensitivity of 67% and 86% and specificity of 71% and 56% for prediction of significant dehydration. Studies from the resource-limited settings were more heterogeneous. One study with acceptable risk of biases reported poor sensitivity (67%) and specificity (49%) of Ao/IVC ratio with cut-off of 2.0 for predicting severe dehydration (>9% weight loss) with area under the curve at 0.6. Three studies showed increase in IVC diameter with fluid resuscitation with mean change in IVC diameter by 30% in children with significant dehydration (>5% weight loss) and by 22% without significant dehydration (<5% weight loss). Metaanalysis was not completed due to high heterogeneity. This study showed that the quantity and quality of research on the application of POCUS for the assessment of dehydration in children is limited. There is no criterion standard for assessing the degree of dehydration and no universal definition of the degree of dehydration. Thus, more methodologically rigorous studies are required. Current systematic review does not support the routine use of US to determine the severity of dehydration in children. Despite these limitations, the use of POCUS in children with dehydration demonstrates potential. Given the clear increase in IVC size with rehydration, repeated IVC US scans may be helpful in guiding fluid resuscitation in children with dehydration. From different proposed US parameters, IVC/Ao ratio has better diagnostic accuracy in detecting significant dehydration than Ao/IVC ratio and IVC collapsibility index. Despite low to moderate diagnostic performance, US still showed better assessment of dehydration than physician gestalt and World Health Organization score.

Point of Care Ultrasonographic Life Support in Emergency (PULSE)—a quasi-experimental study

BackgroundMany physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians’ retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department.MethodsA quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar’s test. A p value of ≤ 0.05 was considered significant.ResultsThere was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p < 0.017), cardiac arrest (p < 0.041), basic ultrasound knowledge (p < 0.001), and undifferentiated shock (p < 0.001).ConclusionAll participants showed improvement in their knowledge and confidence regarding using PoCUS in life-threatening conditions. Through this study, we have also developed an algorithmic approach to managing undifferentiated shock, respiratory failure, and cardiac arrest. Future studies must assess the effectiveness and feasibility of incorporating these algorithms into clinical practice.

Point-of-Care Ultrasound Overview and Curriculum Implementation in Internal Medicine Residency Training Programs in the United States.

Point-of-care ultrasonography (POCUS) augments physical examination and expedites diagnostic care and clinical decision-making. The use of POCUS in internal medicine (IM) appears inconsistent despite its commendable benefits. It is not fully incorporated into the IM residency core competency skills or academic curriculum. This narrative literature review explores the benefits of POCUS and evaluates the need for an IM-focused POCUS curriculum. The obstacles and a proposed curriculum are also described.

A Real-World Experience: Retrospective Review of Point-of-Care Ultrasound Utilization and Quality in Community Emergency Departments.

Point-of-care ultrasound (POCUS) is commonly used in the emergency department (ED) as a rapid diagnostic tool. Emergency medicine (EM) has been an early adopter of POCUS with indications expanding over the last 10 years. While the literature describes widespread use among academic sites, there is little data on clinical POCUS utilization at non-academic EDs. We sought to describe community emergency physician (EP) use of POCUS by quantifying the number and type of studies performed, characteristics of the performing physician, and quality metrics. Prior to the study period, all EPs underwent a standardized training and credentialing program. A retrospective review of all POCUS studies across 11 non-academic EDs from October 1, 2018-September 30, 2020 was performed by fellowship-trained physicians, who identified physician, exam type, and residency graduation year. The studies were then cross-referenced with quality review reports that assessed image acquisition, image interpretation, and image labeling. We performed descriptive statistics. During the study period, 5,099 POCUS studies were performed by 170 EPs. Exams most frequently performed were cardiac (24%), focused assessment of sonography in trauma (21.7%), and pregnancy (16.2%). Recent EM residency graduates (<10 years) were higher utilizers of POCUS with a group mean of 1.3 exams per 100 patients. Of the studies done, 86% had no quality issues. Community POCUS demonstrates a heavy focus on core exams performed by recent EM residency graduates with minimal quality issues after a standardized training program. This study is the first to quantify actual community POCUS use in multiple EDs and may impact credentialing and skills maintenance requirements.

Unlocking the Potential of Point-of-Care Ultrasound in Emergency Airway Management beyond the Operating Room

Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable tool for emergency airway management outside the operating room (OR). POCUS provides real-time imaging capabilities that aid in the evaluation of anatomical landmarks, identification of difficult airways, and verification of endotracheal tube placement. It allows for immediate assessment of airway patency, vocal cord function, and the presence of anatomical abnormalities. This timely information facilitates appropriate interventions and improves patient outcomes. The portability and ease of use of POCUS make it ideal for emergency physicians, paramedics, and other healthcare providers in diverse settings such as pre-hospital care, emergency departments, and intensive care units. It offers rapid image acquisition, which is crucial in situations where immediate access to formal radiological imaging is limited. Successful integration of POCUS in emergency airway management beyond the OR requires adequate training and proficiency in ultrasound techniques. However, the benefits of reduced procedural time, improved success rates, and enhanced patient safety make it a promising modality in the hands of skilled practitioners.

Assessing primary care veterinarians' use of and confidence in performing point-of-care ultrasound.

Point-of-care ultrasound (POCUS) is gaining popularity in the veterinary field, but there is little information on operator confidence. A survey was distributed to primary care veterinarians (PCVs) via social media between May and July 2020. Details of participants' training in and use of POCUS were recorded. Participants' confidence in using thoracic and abdominal POCUS was also assessed using a five-point Likert scale. Two hundred and one PCVs used POCUS, of which 32% reported using a non-standardised protocol. Fifty percent of PCVs were self-taught and 17.4% had attended a specific practical course. The median confidence score was 4 out of 5 (interquartile range [IQR] 2-5) for identifying abdominal abnormalities, irrespective of the training method. The median confidence score for thoracic abnormalities was 3 out of 5 (IQR 1-4) for those taught by a colleague or who were self-taught using journal articles or videos. The survey-based nature of the study relies on self-reporting and is therefore liable to recall bias. PCVs' confidence in usingPOCUS is lacking, particularly with thoracic POCUS. Standardised practical training for PCVs, particularly in thoracic POCUS, would be beneficial. Future studies should explore how best to deliver this training.

A survey of paediatric difficult peripheral intravenous access in the emergency department and use of point-of-care ultrasound.

Peripheral intravenous catheter (PIVC) insertion can be challenging in children, with point-of-care ultrasound (POCUS) known to increase success rates. The objective of this study was to survey how emergency department (ED) clinicians identify and escalate paediatric patients with difficult intravenous access (DIVA), specifically the use of POCUS. This cross-sectional study was conducted in an Australian academic mixed ED that surveyed resident medical officers (RMOs), registrars, consultants and senior paediatric nurses. A 15 multiple-choice questionnaire evaluated clinicians experience with paediatric PIVC insertion, approach to identifying and managing DIVA and the use of POCUS or other adjuncts. Eighty clinicians (34.2% response rate) completed the survey. Poor vein palpability was rated the highest predictor of DIVA. Of the respondents, 19 consultants (86.4%), 28 registrars (90.3%) and 16 RMOs (64.0%) used POCUS as an adjunct for paediatric DIVA patients but 16 consultants (72.8%), 21 registrars (67.8%) and 20 RMOs (80.0%) would use this less than 25% of the time in clinical practice. This survey suggests more clinicians to prefer using objective factors when identifying paediatric DIVA patients, rather than subjectively using gestalt, which relies on clinician experience. Whilst clearly recognised as a useful tool in our study, POCUS was used infrequently for paediatric DIVA patients. There is currently no consistent process for the identification and escalation of paediatric DIVA patients, including the use of adjuncts such as POCUS. Clinician awareness for these issues should be addressed, which should include the development of guidelines and clinician training in POCUS for PIVC insertion in children.

Point-of-Care Ultrasound for the Evaluation and Management of Posterior Cruciate Ligament Injuries: A Systematic Review.

Posterior cruciate ligament (PCL) injuries, though less common than other knee ligament injuries, pose significant management challenges. This study aimed to systematically review and analyze the current evidence on the use of point-of-care ultrasound (POCUS) for the evaluation and management of PCL injuries. It was hypothesized that POCUS has comparable diagnostic accuracy to magnetic resonance imaging (MRI) and that the use of POCUS improves patient outcomes and reduces healthcare costs. A comprehensive systematic review of articles published up to April 2023 was conducted using PubMed, Web of Science, Cochrane, and Scopus databases and adhered to the PRISMA guidelines. Studies were selected based on relevance to the research question, with a focus on diagnostic accuracy, reliability, clinical utility, and cost-effectiveness of POCUS in PCL injuries. Seven studies, analyzing a total of 242 patients with PCL injuries, were included. The reported sensitivity and specificity of POCUS for diagnosing PCL injuries ranged from 83.3% to 100% and 86.7% to 100%, respectively, across the studies. In one study, POCUS demonstrated a positive predictive value (PPV) of 87.9% and a negative predictive value (NPV) of 82.4%. Additionally, three studies reported 100% accuracy in PCL injury detection using POCUS, suggesting a substantial potential for cost savings by eliminating the need for MRI. This systematic review supports the use of POCUS in the evaluation and management of PCL injuries, suggesting that POCUS is a reliable, cost-effective tool with high diagnostic accuracy comparable to that of MRI, offering the potential to improve patient outcomes and reduce healthcare costs. The data collated in this review can inform clinical practice and guide future research in the field.

Point-of-Care Ultrasound and Procedural Instruction in the Family Medicine Clerkship: A CERA Study.

Point-of-care ultrasound (POCUS) education has become a mainstay in resident education in multiple specialties, including family medicine (FM), but literature regarding the use of POCUS during clinical medical student education is lacking. The purpose of this study was to investigate whether and how POCUS education is conducted in FM clerkships in the United States and Canada and how it compares to more traditional FM clinical procedural instruction. As part of the 2020 Council of Academic Family Medicine's Educational Research Alliance survey of FM clerkship directors, we surveyed clerkship directors in the United States and Canada about whether and how POCUS education, as well as other procedural instruction in their institutions and FM clerkships, was conducted. We included questions regarding POCUS and other procedural use by preceptors and faculty. We found that 13.9% of clerkship directors reported structured POCUS education during clerkship, while 50.5% included other procedural training. The survey revealed that 65% of clerkship directors felt that POCUS was an important component of FM, but this was not a predictor of POCUS use in personal or preceptor practice nor of its inclusion in FM clerkship education. Structured POCUS education is a rare component of FM clerkship education; while more than half of clerkship directors felt that POCUS was important for FM, few used it personally or included it in clerkship education. As POCUS continues to be integrated into medical education in FM, the clerkship may represent an opportunity to expand POCUS exposure for students.

Implementation of Point‑of‑Care ultrasound examination in general practice.

Point-of-Care ultrasonography (POCUS) is a method defined as a targeted ultrasound examination of patients with acute symptoms or syndromes that can be diagnosed by a healthcare worker at a site. The aim is to answer a specific diagnostic or therapeutic question or to ease the therapeutic procedure. Recently in Europe, there has been an increase in implementing POCUS in many medical fields including primary health care. The Czech Society of General Practice (SVL ČLS JEP) has for several years been watching the use of POCUS in primary care in many European countries. In August 2020, the committee of the Czech Society of General Practice charged the Working Group for ultrasound in primary care to start a project POCUS iGP - POCUS Implementation in General Practice aiming for the implementation of POCUS into daily practice in general medicine. An ultrasound device is required, as well as setting up the education and training courses with follow up courses and a consensual curriculum of skills, securing quality control mechanisms, proving with scientific evidence the reliability of POCUS when provided by GPs and setting up the final rules of competency and payment for performance. The current international trend of patient centred care in primary health settings and increasing competencies of GPs emphasises a need to implement new point of care diagnostic methods. One of which is point of care ultrasonography. Scientific outcomes and published data from primary care and other fields of medicine show that even doctors who do not work in radiology departments are after a relatively short course able to independently provide POCUS examinations with high reliability. Establishment of the Czech Multidisciplinary Task Force Group for standards, education and research in Pointof- Care ultrasound support development of the POCUS implementation.

Death and Ultrasound Evidence of the Akinetic Heart in Pediatric Cardiac Arrest.

Point-of-care ultrasound (POCUS) is an expanding noninvasive diagnostic modality used for the management of patients in multiple intensive care and pediatric specialties. POCUS is used to assess cardiac activity and pathology, pulmonary disease, intravascular volume status, intra-abdominal processes, procedural guidance including vascular access, lumbar puncture, thoracentesis, paracentesis, and pericardiocentesis. POCUS has also been used to determine anterograde flow following circulatory arrest when organ donation after circulatory death is being considered. Published guidelines exist from multiple medical societies including the recent guidelines for the use of POCUS in neonatology for diagnostic and procedural purposes.

Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda

Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED. 49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%. 31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X2= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X2= 0.85, p 0.38 vs X2= 8.5, p 0.004 respectively). Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings.

Barriers and Facilitators to Point-of-Care Ultrasound Use in Rural Australia.

This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.

The Integration of Point-of-Care Ultrasound into Practical Trauma Training in Ukraine: A Case Study Highlighting Feasibility, Satisfaction, and Pre- and Post-Training Comfort with the Technology

Introduction:As of October 2022, the civilian casualty count of the invasion of Ukraine is reported to be 16,295, with actual figures believed to be considerably higher. As explosive trauma continues to terrorize populations, frontline medical personnel are faced with escalating resource constraints including transport, imaging modalities, and electricity. Point of care ultrasound (POCUS) is considered the gold standard in acute trauma evaluation, but very few hospitals or pre-hospital medics have access to or training in POCUS.Method:In collaboration with the Ukrainian Ministry of Health, the World Health Organization, and the Global Health Program at Butterfly Network, Team Rubicon developed and conducted 64 practical trauma trainings and donated 50 Butterfly iQ+ portable ultrasound devices in Ukraine between August and October, 2022. Of these trainings, 19 specifically focused on the use of POCUS for trauma. Pre- and post-surveys were deployed to determine demographics, comfort level with POCUS for trauma care, and usefulness of the course.Results:In total, 149 individuals were trained in POCUS for trauma. Of these, 130 were physicians, 15 were paramedics, three were RNs, and one was a pharmacist. Only 14.8% of these clinicians self-reported any previous POCUS training. All participants reported an increase in comfort level, with an average pre- and post-course comfort scores of 1.9 and 3.3 (4=very comfortable), respectively. General satisfaction with the training was high (average score of 9.8/10). Qualitative feedback commended the quality and novelty of this training, requested further examples of pathology, and endorsed more POCUS trainings, generally. The most critical lesson learned was the need to re-orient training around the foundations of POCUS given low levels of experience and training.Conclusion:Access and training in POCUS for trauma is critical for resource-constrained medical personnel operating in conflict-affected communities. A one-day POCUS practicum-oriented course is feasible to support awareness and proficiency.

The Frequency of POCUS in the Treatment of Sepsis in the Emergency Department: A Retrospective Cohort Study.

Background: Point of care ultrasound (POCUS) is ubiquitous in the modern emergency department (ED). POCUS can be helpful in the management of patients with sepsis in many ways including determining the cause of sepsis, assessing fluid status, guiding resuscitation, and performing procedures. However, the frequency and manner in which POCUS is incorporated into the care of septic patients in community emergency medicine remains unclear. Objective: To evaluate POCUS frequency and exam types used in the care of patients with sepsis in two community EDs in Southern California. Methods: We performed a retrospective analysis of 5,264 ED visits with a diagnosis of sepsis at two community emergency departments between January 2014 and December 2018. Patients 18 years or older who were diagnosed with sepsis and had either lactate ≥ 4 mmol, a documented mean arterial pressure (MAP) < 65 mmHg, or a systolic blood pressure (SBP) < 90 mmHg were included. Charts were reviewed to determine if POCUS was used during the ED evaluation. Primary outcomes were frequency of POCUS use in the cohort, change in POCUS use over the study period, and the types of exams performed. Results: POCUS was used in 21% of encounters meeting inclusion criteria and was positively correlated with ED arrival year (OR = 1.09; CI 1.04, 1.15; p=0.001). The most common POCUS exam was ultrasound-guided central line placement, with the next most common exams being cardiac, followed by inferior vena cava (IVC). Only the frequency of cardiac, IVC, lung and Focused Assessment with Sonography in Trauma (FAST) exams were found to increase significantly over the study period. Conclusions: Total POCUS use increased significantly in this cohort of septic patients over the study period due to more cardiac, IVC, lung and FAST exams being performed.

Point-of-Care Ultrasound Attitudes, Barriers, and Current Use Among Family Medicine Residents and Practicing Physicians.

Point-of-care ultrasound (POCUS) has high interest among learners and educators, but many barriers inhibit training and clinical use. Interest and barriers may differ between educators, trainees, and practicing physicians. This study investigates interest in POCUS, confidence in POCUS skills, and barriers to POCUS use for residents, academic family physicians, and community providers. Online surveys sent to current residents, faculty, and graduates of an academic family medicine residency compared current use, comfort, training, perceived importance, barriers, and interest in future use of POCUS. Most participants (95.6%) agreed that POCUS was somewhat or extremely important to family medicine. Most participants also reported interest in all POCUS indications, other than obstetrics. Very few (5.4%) reported being extremely comfortable using POCUS. Most residents were somewhat comfortable, whereas most faculty and graduates were not at all comfortable. A majority in each group reported inexperience with equipment and interpreting images as a barrier. One-third of faculty and graduates reported "not billable" as a barrier. Statistically significant differences were found between groups' reports of prior training, current use, and interest in POCUS for obstetrics. Family medicine residents, faculty, and community physicians reported high perceived importance of and interest in nonobstetric POCUS, but low comfort level in performing POCUS. Resident and faculty barriers may vary according to practice environment and differing time constraints. Senior faculty may have less POCUS training and comfort using POCUS than residents, highlighting the importance of continuing faculty education.

Current Use, Training, and Barriers of Point-of-Care Ultrasound in Anesthesiology: A National Survey of Veterans Affairs Hospitals

The purpose of this study was to determine current use, training needs, and barriers to point-of-care ultrasound (POCUS) use among anesthesiologists in practice. Multicenter, prospective, observational study. Anesthesiology departments in the Veterans Affairs Healthcare System in the United States. Chiefs of staff and chiefs of anesthesiology departments. A web-based survey was conducted between June 2019 and March 2020. Chiefs of staff answered questions about facility-level POCUS use, training, competency, and policies. Anesthesiology chiefs responded to a follow-up survey with specialty-specific POCUS questions. The results of the 2020 survey were compared with a similar survey conducted by the authors' group in 2015. All chiefs of staff (n=130) and 77% of anesthesiology chiefs (n=96) completed the survey. The most common POCUS applications used were central and peripheral vascular access (69%-72%), peripheral nerve blocks (66%), and evaluation of cardiac function (29%-31%). Compared with 2015, there was a statistically significant increase in desire for training (p=0.00015), but no significant change in POCUS use (p=0.31). Training was most desired for volume-status assessment (52%), left ventricular function (47%), pneumothorax (47%), central line placement (40%), peripheral nerve blocks (40%), and pleural effusion (40%). The most common barriers to POCUS use were lack of funding for training (35%), trained providers (33%), and training opportunities (28%). A significant increase in desire for POCUS training was seen among anesthesiologists practicing in the Veterans Affairs healthcare system since 2015, and lack of training continues to be a top barrier for POCUS use among anesthesiologists.

Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach.

Point of care ultrasound (POCUS) is a cost-effective, non-invasive procedure with high diagnostic reliability and therapeutic utilities. For various reasons, it is not being used routinely in neurosurgical intensive care unit (ICU). We have introduced a systematic use of POCUS in critically ill patients in our neurosurgical ICU. We have studied the various indications and benefit of using this technique. This is a prospective, single center cohort observational study done in patients who were admitted in a tertiary neurosurgical ICU over 1 year (17th September 2020 to 16th September 2021). POCUS was used daily as per a standardized format for multiple purposes. A formal training to the operator was provided and standardized method of evaluation and intervention was used. Outcome was studied to understand the impact of the POCUS and difficulties encountered during its use. POCUS was used in 240 patients, including all patients for primary and secondary surveys, 192 patients (80%) for optic nerve sheath diameter (ONSD) measurement, 14 myelomeningoceles for trans-fontanelle ultrasound study, 16 post operative cases of aneurysm clipping for transcranial Doppler (TCD) study, 86 patients for deep vein thrombosis (DVT) screening, 17 for evaluation of ventriculo-peritoneal (VP) shunt functionality, 30 for transcranial defect ultrasound, 45 for chest ultrasound, 4 for evaluation of hemodynamic shock and 67 patients who had difficult cannualtion or while insertion of central venous catheter placement. POCUS was also used for difficult cannulation, central catheter placement and e-FAST scan. Significant findings were reported 129 times, which led to immediate change in management in 62 patients (25.83%) as compared to 16 patients in whom significant findings were not reported using POCUS, but management was changed using other radiological modalities (P<0.01). There was initial lag in adopting the technique, however with practice, the team developed confidence. As a result, the accuracy and time taken to perform the procedure was reduced significantly. Routine systematic use of POCUS can be beneficial not only for the rapid diagnosis and prompt management of patients, but also helpful in monitoring and performing various procedures in neurosurgical ICU. Though not all modalities mentioned in standardized format was used in all patients, use of this format has helped improved training and maintain proper use of POCUS in our ICU.