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Utility and potential of bedside ultrasound in palliative care.

Dhamija E, Thulkar S, Bhatnagar S - Indian J Palliat Care (2015 May-Aug)

Bottom Line: It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures.With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards.It also enhances patient comfort and reduces cost burden.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Dr. Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards. Major applications of bedside ultrasound include drainage of malignant pleural effusions and ascites, nerve blocks, venous access, evaluation of urinary obstruction, deep vein thrombosis and abscesses. Bedside ultrasound leads to better clinical decision-making as well as more accurate and faster invasive therapeutic procedures. It also enhances patient comfort and reduces cost burden. However, use of bedside ultrasound is still not widespread among palliative care givers, owing to initial cost, lack of basic training in ultrasound and apprehensions about its use. A team approach involving radiologists is important to develop integration of bedside ultrasound in palliative care.

No MeSH data available.


Related in: MedlinePlus

Hemorrhagic pleural effusion: Chest X-ray (a) of a woman with breast cancer shows opaque left hemithorax with mediastinal shift to right. Multiple nodular metastases are also seen in right lung. Ultrasound of chest (b) confirms presence of pleural effusion. In addition, there are fine internal debris (asterisk) and septation (arrow) within
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Figure 1: Hemorrhagic pleural effusion: Chest X-ray (a) of a woman with breast cancer shows opaque left hemithorax with mediastinal shift to right. Multiple nodular metastases are also seen in right lung. Ultrasound of chest (b) confirms presence of pleural effusion. In addition, there are fine internal debris (asterisk) and septation (arrow) within

Mentions: Malignant pleural effusions causing dsypnea are treated with thoracocentesis. Single-time needle aspirations are initially performed, however, recurrent fluid re-accumulations are common which require in dwelling catheters. Use of USG-guided percutaneous placement of small bore tubes, such as pigtail catheters, can be as effective as surgically placed chest tubes and also easier to maintain.[678] After adequate control of pleural drainage, these can also be used to perform chemical pleurodesis for lasting palliation of malignant pleural effusion.[9] Bedside USG, along with chest radiographs, is useful for initial evaluation and to select the patient for small bore catheter drainage of symptomatic malignant pleural effusion. Opacities diagnosed as pleural effusion on chest radiographs may actually contain large pleural deposits or primary tumor itself with little free effusion. This is easily detected on USG. Catheter drainage of such effusion is unlikely to help relieve dyspnea and hence, unnecessary drainage procedure can be avoided. USG can also demonstrate multiple loculations in pleural effusion, which is a relative contraindication for thoracocentesis [Figure 1].


Utility and potential of bedside ultrasound in palliative care.

Dhamija E, Thulkar S, Bhatnagar S - Indian J Palliat Care (2015 May-Aug)

Hemorrhagic pleural effusion: Chest X-ray (a) of a woman with breast cancer shows opaque left hemithorax with mediastinal shift to right. Multiple nodular metastases are also seen in right lung. Ultrasound of chest (b) confirms presence of pleural effusion. In addition, there are fine internal debris (asterisk) and septation (arrow) within
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4441172&req=5

Figure 1: Hemorrhagic pleural effusion: Chest X-ray (a) of a woman with breast cancer shows opaque left hemithorax with mediastinal shift to right. Multiple nodular metastases are also seen in right lung. Ultrasound of chest (b) confirms presence of pleural effusion. In addition, there are fine internal debris (asterisk) and septation (arrow) within
Mentions: Malignant pleural effusions causing dsypnea are treated with thoracocentesis. Single-time needle aspirations are initially performed, however, recurrent fluid re-accumulations are common which require in dwelling catheters. Use of USG-guided percutaneous placement of small bore tubes, such as pigtail catheters, can be as effective as surgically placed chest tubes and also easier to maintain.[678] After adequate control of pleural drainage, these can also be used to perform chemical pleurodesis for lasting palliation of malignant pleural effusion.[9] Bedside USG, along with chest radiographs, is useful for initial evaluation and to select the patient for small bore catheter drainage of symptomatic malignant pleural effusion. Opacities diagnosed as pleural effusion on chest radiographs may actually contain large pleural deposits or primary tumor itself with little free effusion. This is easily detected on USG. Catheter drainage of such effusion is unlikely to help relieve dyspnea and hence, unnecessary drainage procedure can be avoided. USG can also demonstrate multiple loculations in pleural effusion, which is a relative contraindication for thoracocentesis [Figure 1].

Bottom Line: It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures.With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards.It also enhances patient comfort and reduces cost burden.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Dr. Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards. Major applications of bedside ultrasound include drainage of malignant pleural effusions and ascites, nerve blocks, venous access, evaluation of urinary obstruction, deep vein thrombosis and abscesses. Bedside ultrasound leads to better clinical decision-making as well as more accurate and faster invasive therapeutic procedures. It also enhances patient comfort and reduces cost burden. However, use of bedside ultrasound is still not widespread among palliative care givers, owing to initial cost, lack of basic training in ultrasound and apprehensions about its use. A team approach involving radiologists is important to develop integration of bedside ultrasound in palliative care.

No MeSH data available.


Related in: MedlinePlus