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December 2017

The Practice and Implications of Finding Fluid During Point-of-Care Ultrasonography: A Review

Author Affiliations
  • 1Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
  • 2Medicine (General Medicine), Yale School of Medicine, New Haven, Connecticut
  • 3Medicine (Cardiology), Yale School of Medicine, New Haven, Connecticut
  • 4Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
  • 5Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2017;177(12):1818-1825. doi:10.1001/jamainternmed.2017.5048

Importance  Point-of-care ultrasonography (POCUS) is an increasingly affordable and portable technology that is an important part of 21st-century medicine. When appropriately used, POCUS has the potential to expedite diagnosis and improve procedural success and safety. POCUS is now being adopted in medical education as early as the first year of medical school. While potentially powerful and versatile, POCUS is a user-dependent technology that has not been formalized or standardized yet within internal medicine residency training programs. Physicians and residency directors are trying to determine whether to incorporate POCUS, and if so, how. In this systematic review, basic concepts and applications of POCUS are examined, as are issues surrounding training and implementation.

Observations  A key use of POCUS is to detect fluid, and this is a cornerstone of POCUS teaching. Even in inexperienced hands, POCUS has shown to be more sensitive and specific than physical examination for conditions such as ascites, pleural effusion, and pericardial effusion. Detecting fluid requires a basic understanding of ultrasonography operation, sonographic anatomy, and probe orientation. Once fluid is localized, ultrasonographic guidance can increase success and decrease complications of common procedures such as thoracentesis or paracentesis.

Conclusions and Relevance  POCUS can augment physical examination and procedural efficacy but requires appropriate education and program setup. As POCUS continues to spread, internal medicine physicians need to clarify how they intend to use this technology. Equipment is now increasingly accessible, but programs need to determine how to allocate time and resources to training, clinical use, and quality assurance. Programs that develop robust implementation processes that establish proper scope of practice and include quality assurance that use image archival and feedback can ensure POCUS will positively impact patient care across hospital systems.

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