Teleguided Point-of-Care Ultrasound for Fluid Assessment in Geriatric Inpatients Performed by Nurses and Medical...

Fluid assessment in geriatric inpatients is challenging, as clinical signs are often unreliable. Inferior vena cava (IVC) ultrasound provides a rapid, noninvasive estimation of intravascular volume. Teleguided point-of-care ultrasound (POCUS) allows examiners without prior ultrasound experience to perform scans under real-time supervision.

This study aimed to evaluate the feasibility, accuracy, efficiency, and user satisfaction of remote-guided IVC ultrasound performed by medical students and nurses without prior ultrasound experience in a geriatric inpatient setting.

This prospective feasibility study was conducted between February and March 2025 in a geriatric inpatient ward at a German tertiary care hospital. Thirty hospitalized geriatric patients were recruited using a pragmatic convenience sampling approach on predefined study days. Each patient underwent 2 IVC ultrasound examinations (n=60) using a handheld device with TeleGuidance; one was performed by a medical student and one by a nurse. All scans were remotely supervised by an ultrasound-experienced cardiologist, who subsequently performed a third, independent IVC scan on each patient, serving as the reference standard. Examiners were 2 final-year medical students and 2 nurses, all without ultrasound experience, each performing 15 scans. Primary outcomes were technical feasibility (successful teleguidance connection), accuracy of IVC diameter measurement (≥80% within +2 mm to -2 mm), and examination duration (≤10 minutes). The secondary outcome was user satisfaction (≥75 on a 0-100 numeric rating scale).

Connectivity and remote supervision were consistently stable, enabling completion of all scans (feasibility 100%). IVC visualization was successful in 90% (27/30) of cases. Accuracy was achieved in 80% (48/60; 95% CI 67-88) of scans. Mean duration was 3.3 (SD 2.0) minutes. Mean user satisfaction was 89%, with all ratings ≥85%.

Telemedicine-guided IVC ultrasound was feasible and well accepted in this geriatric inpatient setting. Nonexpert examiners were able to obtain clinically usable measurements under remote supervision within a few minutes after minimal training. These findings suggest that teleguided POCUS is a promising approach to support task sharing in geriatric care. Further studies are needed to confirm these results and to evaluate integration into clinical practice.

German Clinical Trials Register DRKS00035821; https://www.drks.de/search/de/trial/DRKS00035821/details.