Citation: Mao H, Dong M, Zhao H, Dong N. The Clinical Value of Serum AFP, AFP-L3 and DCP alone and in Combination in the Diagnosis of Primary Liver Cancer. Japanese J Gastroenterol Res. 2022; 2(15): 1122.

Introduction

The COVID-19 pandemic has led all to important changes in clinical practice, having to reorganize many protocols and procedures to deal with patients in, sometimes, disadvantageous situations, such as when it is necessary to wear heavy and uncomfortable Personal Protective Equipment (PPE). In late 2019, new coronavirus pneumonia (coronavirus disease 2019, COVID-19) flared up in Wuhan, China. 

Immediately after the world

The World Health Organization (WHO) has characterized COVID-19 as a pandemic. COVID-19 brings big morbidity and mortality and aspects of excessive work load rigorous use of PPE, invisible clinical needs and comfort patients and family in difficult situations make this disease a huge challenge. The use of nursing ultrasound in emergency department’s offers nurses the opportunity to improve care perform some procedures with greater ease and safety. These include peripherals venous and arterial punctures, pulmonary evaluation positioning of a gastric tube, evaluation of the inferior vena cava and bladder volume and skin protection. 

Implications of clinical practice

This manuscript describes in 6 points, the practical implications of nursing ultrasound in emergency departments. 

Ultrasound-guided vascular catheterization can greatly improve success by reducing implantation speed, avoiding multiple venipunctures, reducing the incidence rate of complications, improving the clinical level, increasing asepsis maneuvers and providing a strong guarantee for catheterization hard. The use of nursing ultrasound in the field of venous access involves numerous benefits and must be promoted in case of severe COVID-19 in patients with difficulty in finding venous access.

Chest and abdomen radiography is the preferred examination to verify correct positioning, but it is also a method that exposes the patient to radiation with an important increase in economic and organizational costs, fundamental aspects during the COVID-19 pandemic. The position of the gastric tube by ultrasound can avoid and reduce the onset of complications of enteral nutrition and effectively reduce the harm to severe COVID-19 patients. 

Ultrasound monitoring of residual gastric volume can accurately assess the gastric emptying function of patients with severe COVID-19, which has certain which means guide for patients to accept enteral nutrition and reduces the risk of occupational exposure of nurses, and allows for better non-invasive ventilation. 

Pulmonary ultrasound can quickly determine the cause of hypoxia in severe conditions COVID-19 patients and carefully guide the respiratory management of severe COVID-19 patients. Pulmonary ultrasound, as widely demonstrated, is of great help for the correct evaluation of the ventilation modality, and of the correct prioritization of triage. 

Pelvic nursing ultrasound is a non-evaluation method invasive of the volume of the bladder, its contents, and the intravesical salience of the prostatic-trigonal resion and the real-time determination of the positioning of the catheter bladder. It does not have diagnostic purposes, but to support operational procedures and has been fundamental in the assistance of patients suffering from severe covid19. 

Nursing Ultrasound of the inferior vena cava was found to be fundamental in the nursing care of the patient affected by covid-19 to evaluate the status of the circulating volume. 

The application of ultrasound can make nursing care more accurate and objective in clinical work and discover changes in patients with severe COVID-19 ‘by reducing time and acting preventively with targeted assistance interventions. 

Ultrasound-guided venous/arterial access

Low success rates of peripheral and arterial veins during puncture with PPE (disposable cap, protective goggles and / or protective visor, protective surgical mask, FFP2 / FFP3 mask, disposable clothing, two disposable latex gloves, disposable shoe covers, disinfectant), the protective goggles can easily form fog, thus hindering the smooth insertion of the catheter. The ultrasound-guided puncture provides greater possibility of success in catheter placement, especially in urgency. Working with the double glove reduces the operator’s sensitivity in arterial puncture, fundamental in hemodynamic and respiratory monitoring in emergency departments, Ultrasound-guided catheterization was found to be essential to reduce the cost and complications of puncture. 

Ultrasound guided positioning of the nasogastric tube

 Difficulty in positioning a gastric tube Nasogastric tube placement is the simplest and most common method used to provide short-term enteral nutrition. Nasogastric tube placement could cause coughing in patients, resulting in a risk of perfusion droplets and easily causing occupational exposure [1]. Also, with covid 19 PPE the ears are wrapped in protective clothing and the gurgling sound cannot be heard on auscultation. If the gastric contents cannot being aspirated through the gastric tube, it is very difficult to correctly assess gastric tube placement. Proper Control it is absolutely necessary to position the tube before starting enteral feeding to avoid complications such as aspiration pneumonia. If a double trace mark was observed when scanning the long axis of the esophagus with ultrasound then it is believed that a nasogastric tube has entered the esophagus. Meanwhile, if a double trace sign is observed in the gastric body, therefore it can be judged as being placed in the stomach. Furthermore, through the water injection test, one can judge whether or not there is a “Fogging” effect. 

Gastric residual ultrasound monitoring

 Monitoring of residual gastric volume with the conventional method presents risks Residual gastric volume should be monitored for severe COVID-19 patients at high risk of aspiration every 4 hours, but taking the gastric residue with a syringe presents the risk of splashing of gastric contents. There is good correlation between “gastric antrum area measured by gastric ultrasound single section antral method “and” volume of gastric contents “. The use of ultrasound to measure the area of the gastric antrum to evaluate the residual gastric volume substantially reduces a nurse’s risk occupational exposure. 

Thoracic nursing ultrasound

 Difficulty assessing pulmonary efficacy pulmonary ultrasound facilitates the determination of the duration and frequency of the prone position. Dynamically monitor the progression of the disease and evaluate it efficacy of ongoing therapy based on the increase and decrease of B. lines, areas of line B and consolidation area and volume with the use of predefined protocols such as the BLUE protocol [2]. 

Nursing pelvic ultrasound and ultrasound-guided bladder catheter placement

 Nursing pelvic ultrasound is a method for assessing the volume of the bladder, it is of fundamental importance for the assessment and adequate haemodynamic management of the patient in the emergency departments this type of ultrasound was also very useful for facilitating the aseptic insertion of the bladder catheter while maintaining correct use of PPE. 

Nursing ultrasound of the vena cava

Ultrasound of the inferior vena cava is fundamental in the urgent evaluation of any state of shock, for a correct care classification by the nursing staff, numerous studies in the literature show how a correct ultrasound examination can facilitate the care pathway in emergency departments, especially in patients with severe covid-19.

Nursing ultrasound

 Difficulty detecting emergency events early in COVID-19 patients the condition of patients with severe COVID-19 can change rapidly when patients’ vital signs change, ultrasound can be used to quickly rule out the underlying cause. For example, if a patient has dyspnea and a reduced oxygen saturation in the blood, the nurse can quickly judge the cause through lung ultrasound, facilitating the correct path of care and above all by identifying early complications.

Conclusion

In summary, through visual qualitative and quantitative assessments, critical nursing ultrasound supports a goal-oriented care strategy that may be useful in caring for severe COVID-19 patients. In addition, the use of ultrasound allows you to perform nursing care with a more advanced level of safety for the healthcare professional and for the patient.

Declarations

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Authors’ contributions: All authors read and approved the final version of the manuscript.

References

1. Walldorf J, Michl P, Krug S. The nasogastric tube is stuck - and causes coughing and dyspnoea: A rare complication. Intensive Crit Care Nurs. 2020; 57: 102786.
2. Wolde Sellasie K, Rapaccini FR, Biondi I, Barbera C, Di Vito R, Silvi L, et al. Nursing ultrasound and COVID-19: a new alliance. Ital J Emerg Med. 2021; 10: 89-90.