Intra- and Inter-Operator Reliability of Internal Jugular Vein Ultrasound Image Acquisition by Ultrasound-Naive...

Background: Venous congestion assessment is essential in heart failure management. Inferior vena cava (IVC) ultrasonography has been widely used to determine fluid status but may not always provide satisfactory images. Hence, internal jugular vein (IJV) ultrasonography has been proposed as an alternative; however, the reliability of IJV ultrasound image acquisition by nurses without previous clinical ultrasound experience remains unclear. This study evaluated the intra- and inter-operator reliability of IJV ultrasound image acquisition by nurses without previous clinical ultrasound experience. Methods: Two nurses without prior clinical ultrasound experience acquired right IJV ultrasound images after preparatory training. Short-axis cine loops were obtained during quiet breathing and the Valsalva maneuver in healthy adults. A single investigator measured the major and minor diameters from selected still frames. Intra- and inter-operator reliability were then assessed using intraclass correlation coefficients (ICCs), after which agreement was evaluated by Bland-Altman analysis. Results: Both nurses successfully acquired IJV images suitable for subsequent quantitative analysis from all participants. Intra-operator reliability ranged from good to excellent, with ICC (1, 1) values of 0.765-0.967. Meanwhile, inter-operator reliability ranged from moderate to excellent, with ICC (2, 1) values of 0.629-0.916. Bland-Altman analysis revealed fixed bias in three parameters but no proportional bias. Absolute bias was <1 mm for all measurements. Conclusions: Following preparatory training, nurses without prior clinical ultrasound experience were able to acquire IJV ultrasound images with moderate-to-excellent inter-operator and good-to-excellent intra-operator relative reliability.