Even established medical practices like dialysis can benefit from new approaches. A Kootenay Boundary Regional Hospital team pooled their skills to search for a safe way to remove lung fluids during dialysis treatment. The team followed their hypothesis and analyzed the side effects of fluid retention on hemodialysis patients. Their goal was to see what benefits lung ultrasounds could provide for patients experiencing hypertension during treatment.
The Lung Ultrasonographic Assessment of Volume Status in Hemodialysis team was keen to test Point of Care Ultrasound (POCUS) to identify extravascular lung water volume overload. It requires care and accuracy before taking action.
“If you remove fluid too excessively, it can precipitate low blood pressure, loss of consciousness, heart attacks,” said DharmaPaul L. Raju MD (Nephrologist and Project Coordinator). “It can be quite dangerous.”
Results give new insights and options
The team members represented the variety of service providers a dialysis patient might come in touch with during treatment. This Physician Quality Improvement project was conducted by Justin Dragoman (Medical student), Chi Zhang MD (Chief of Nephrology and the Department of Medicine), Marlene Johnson RN (Dialysis Nurse), and Dharma Paul L. Raju MD (Nephrologist and Project Coordinator) at KBRH.
The lung ultrasound results demonstrated a statistical decrease in the overall time patients were hypertensive while on dialysis. Also, the ultrasound allowed the researchers to identify patients with sub-clinical congestive heart failure (those without signs or symptoms of heart failure) who benefited from additional fluid removal. Most of the test patients were asymptomatic, leading to improved targeted ultrafiltration (UF) for patients with subclinical volume overload.
UBC Medical student Justin Dragoman explained how the first step was to assess how often patients were becoming hypotensive during treatment. “We determined patients spent about 40 percent of their time in hypotension when they are undergoing a dialysis session.”
Using lung ultrasound technology helped reduce the patient’s time in hypotension by 12 percent and deal with low blood pressure issues.
Looking to the future
“As physicians, we want to make sure we improve patient outcomes,” said Chi Zhang MD, Chief of Nephrology and the Department of Medicine. “But also we want to improve their physical well-being and experience with dialysis.”
Lung ultrasonography has already been utilized by ICU and Emergency Room physicians. The project plans to expand throughout Interior Health and engage students and nurses throughout the region. Using this simple invaluable bedside tool can enhance patient safety in rural areas without easy access to hospital services.
Review this project report here
If you want to learn more about this initiative or anything else about living and working as a physician in Kootenay Boundary, please get in touch with Sylvain Turgeon, Head of the KB Doctors Recruitment Team.
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