Tehnike i metode učenja pregleda donje šuplje vene ultrazvukom u svrhu procjene centralnog venskog tlaka i volumnog statusa

master's thesis

• Title (english): Techniques and methods of teaching ultrasound examination of the inferior vena cava for the purpose of central venous pressure and volume status assessment
• Author: Ivan Zekanović
• Mentor: Radovan Radonić (mentor)
• Committee member: Luka Bielen (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Radovan Radonić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

U ovom istraživanju pokušali smo procijeniti broj pregleda ultrazvukom potrebnih da
student medicine nakon praktične i teorijske obuke dosegne zadovoljavajuću razinu u
procjenjivanju centralnog venskog tlaka (CVT) pregledom donje šuplje vene (DŠV)
ultrazvukom. Također smo provjerili je li neki od pristupa za dobivanje slike superiorniji nad
ostalima.
Promjer DŠV mjeren je u inspiriju i ekspiriju pristupom iz epigastrija i interkostalnim
pristupom. U oba pristupa DŠV je mjerena na poprečnom i uzdužnom prikazu. Svakog
bolesnika ultrazvukom su pregledali student i iskusni liječnik vičan ultrazvuku. Za svaki pristup
su procijenili CVT na temelju promatranja kolabiranja donje šuplje vene tijekom disanja te
proveli mjerenja promjera vene i na temelju njih procijenili tlak koristeći ASE tablicu. Niti
jedan ispitivač nije imao uvid u rezultate drugog ispitivača kao niti u vrijednost CVT-a
izmjerenog pomoću postavljenog centralnog venskog katetera.
U istraživanje je bilo uključeno 30 bolesnika. Nakon prvih 15 bolesnika podudaranje
između studenta i specijalista prema Cohenovom kapa koeficijentu se nalazilo u stupnju
blagoga podudaranja kako za slobodnu procjenu kategorije CVT-a tako i za mjerenja u B i M
modu ultrazvuka, a nakon pregledanih idućih 15 bolesnika podudaranje se poboljšalo do stupnja
umjerenog podudaranja oba ispitivača za slobodnu procjenu i za mjerenja u B i M modu.
Nakon 30 pregleda ultrazvukom student je poboljšao svoje sposobnosti procjene CVTa
na temelju pregleda DŠV ultrazvukom. Niti iskusni specijalist nije pokazao da može precizno
procijeniti CVT ovom metodom u populaciji intenzivističkih bolesnika u kojih osim volemije i
drugi čimbenici utječu na promjer DŠV. Stoga nije moguće sa sigurnošću procijeniti studentovu
osposobljenost za upotrebu ove metode nakon pregledanih 30 bolesnika. Slobodna procjena
pokazala se manje uspješnom za predikciju CVT-a nego metoda temeljena na mjerenjima.
Različite metode mjerenja, uz uzdužni ili poprečni prikaz DŠV, iz epigastrija ili interkostalnim
pristupom, te u B ili u M modu nisu pokazale značajnu međusobnu razliku.

Abstract (english)

The aim of this study was to assess the number of ultrasound examinations needed for
the medical student to reach a reasonable level of proficiency in ultrasonic evaluation of central
venous pressure (CVP), and to check the value of different inferior vena cava (IVC) assessment
methods in CVP estimation.
The diameter of the IVC in the inspiration and the expiration was evaluated and
measured by the epigastric and the intercostal approach, showing the transverse and
longitudinal section in the B and M modes. Without insight into the value of CVP and the results
of other examiner, a student and a specialist experienced in ultrasonography examined each
patient. CVP was predicated by free evaluation and by the reading from the ASE table based
on the measurements. Neither examiner had insight into other examiners results nor had the
examiners insight into the CVP measured via the central venous catheter.
Thirty patients were included in the study. After the first 15 patients, the agreement
between the student’s and the specialist’s categorization of CVP according to the Cohen’s
kappa coefficient was in a slight degree for both the free evaluation of CVP and B and M mode.
After the examination of the next 15 patients, the agreement was in the fair degree for both the
free evaluation of CVP and B and M mode.
After 30 ultrasound examinations the student improved his capabilities of assessing
CVP based on ultrasonic evaluation of IVC. Experienced specialist, as well as student, wasn’t
efficient in accurate assessment of CVP by this method in the population of adult intensive care
unit patients that, besides volume status, had other factors that influence the diameter of IVC.
Therefore it is not possible to assess the student’s capabilities of using this method with
certainty after examining 30 patients. The free estimate was found to be less accurate in CVP
prediction than the measurement of the IVC diameter. With the respect to the CVP prediction,
no significant differences were found between the measurements in the longitudinal or
transverse plane as well as between examinations from the epigastrium or intercostal spaces.
This was found in both B and M mode.

• Keywords: donja šuplja vena; centralni venski tlak; ultrazvuk
• Keywords (english): inferior vena cava; central venous pressure; ultrasound
• Language: croatian
• URN:NBN: urn:nbn:hr:105:308551
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-03-03 08:41:16