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Updated: Jun 4, 2026

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
Development and validity of tutorial guide for using lung ultrasound to identify "Excessive Fluid Volume" nursing
Maria Camila Rodrigues1, Thiago Vital da Silva1, Hellen Caroline da Silva Teixeira1
1Nursing Paulista School, Federal University of São Paulo, São Paulo, Brazil.
Abstract:
PurposeThe purpose of this study was to create and assess the content validity of a tutorial guide to identify the "Excessive Fluid Volume" nursing diagnosis in individuals with heart failure using lung ultrasound.MethodsThe study was divided into two phases. In the first phase, a literature review was conducted with the aim of developing a tutorial guide for performing lung ultrasound (LUS) to identify the "Excessive Fluid Volume" nursing diagnosis. In the second phase, the developed tutorial guide was initially assessed by a group of experts to assess the stages for image acquisition. Subsequently, another group of experts assessed the tutorial guide in terms of its indications, interpretation, and management. The content validity ratio (CVR) was calculated to analyze the agreement among experts.ResultsA total of 24 articles were included in the tutorial guide development. Initially, the guide was assessed by 10 experts, and after three rounds, a critical CVR value was obtained. In the second phase, the guide's indications, interpretation, and management were assessed by 14 nurses, achieving a CVR value of 1.0. The guide includes three indications for insonation, 17 stages related to acquiring pulmonary insonation, three possible interpretations of ultrasound images to identify the defining characteristics of pulmonary congestion and pleural effusion, and five potential nursing interventions.ConclusionThe tutorial guide for identifying the "Excessive Fluid Volume" diagnosis in patients with heart failure was developed and demonstrated adequate evidence of content validity.Implications for practiceThe tutorial guide developed can be used by nurses to assess the presence of the "Excessive Fluid Volume" diagnosis in different nursing care scenarios for patients with heart failure.
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