Impact of an advanced nurse practitioner ultrasound service in the postoperative cardiac surgery patient

Purpose: Routine post operative CXR’s are usually performed on day 1 and 4 in UK centres. Additional imaging is requested if clinically indicated. Training ANP’s to perform bedside ultrasound reduces the numbers of CXR’s patients are exposed to and earlier diagnostic confirmation of clinical concern enables timely intervention.

Methods: The ANP team routinely performed daily ultra sound examination of the chest developing skills to perform reliable diagnostic procedures. Patient consent was obtained, ANP was taught to identify key landmarks, perform the scan and interpret the findings providing a diagnoses. Findings were compared against the routine CXR to see if they concurred, gave further information and if any required intervention could have been orchestrated earlier. Each ANP was expected to perform supervised scanning, reporting and recording of findings to be signed off as competent against the unit document that was established. This is stored in the ANP’s portfolio and records.

Results: A pilot study of 20 CXR’s & Ultrasounds is being completed and early results suggest that the ANP’s are a reliable and consistent team to perform the scan. Their clinical findings concur with the radiological findings and any required intervention can be actioned earlier. Patients do not need to be taken to the X–Ray department, using valuable human resources and an unnecessary journey. For those patients having a bedside CXR the disruption to the unit and patient is reduced. Moreover, there it avoids the cost of CXR investigations.

Conclusions: The ANP team having established a reliable diagnostic service that confirms routine recovery, earlier detection of clinical issues, reduces patient exposure to radiological images and has resulted in an additional skill to advance their practice. The pilot study will be expanded to underpin the findings.