Broadening the Scope of Practice for Respiratory Therapists with Ultrasound

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Picture of Gene Macogay, MSc, RRT, RRT-ACCS
Gene Macogay, MSc, RRT, RRT-ACCS

Registered Respiratory Therapist since 2010. Master of Science in Respiratory Care Leadership from Northeastern University. Still practicing bedside prn and working as full-time as the Director of Clinical Education at St. Petersburg College in Florida. Interests include mechanical ventilation, fundamentals of respiratory care and digging into research articles. My favorite part of my job is helping people discover their potential in this field.

The Pre-brief

Respiratory therapists (RTs) add value to the healthcare team by providing knowledge and competent skill sets to assist in the diagnosis, treatment and management of patients that require cardiopulmonary services. The areas of care range from basic therapies to emergent and critical care to prolonged and management services. Incorporating the use of ultrasound (US) technology has the potential to allow RTs to expand their roles and provide better outcomes.

Acquiring the Skill

In 2019, Karthika et al. mentioned that, after a short training, RTs were independently capable of performing lung ultrasounds with greater than 95% accuracy. Additionally, less than 2% of the RTs trained required assistance in obtaining an image and less than 5% of the images acquired were interpreted incorrectly. 

Potential Uses of Ultrasound

  • The use of ultrasound (US) provides a safe, efficient bedside tool to assess acutely compromised, ventilated patients for a pneumothorax without transport of unstable patients for imaging scans. This may allow for timely intervention to rectify ventilator settings.  
  • US may be used quickly to assess diaphragmatic function and movement as a prime indicator of spontaneous breathing efforts. A prospective cohort study using US demonstrated that significant decreases in diaphragmatic thickness, diaphragmatic thickness fraction and dystrophy were associated with increased length and duration of mechanical ventilation; making US sensitive to predicting weaning outcomes. Another study found that assessment via US for diaphragmatic movement and lung aeration were superior to blood gases and respiratory mechanics for predicting the weaning process and successful extubation vs. post-extubation distress and failure.
  • US for airway management is useful for a variety of situations including endotracheal tube placement verification, prediction of difficult intubation, detection of subglottic stenosis, prediction of post-extubation stridor and confirmation of laryngeal mask airway placement.  
  • In some facilities, RTs are responsible for placement of radial arterial catheters. In 2016, Miller and Bardin concluded that training in the use of US for placement of radial arterial catheters should be encouraged for all practitioners who place them. In their article, they highlight: real-time visualization of landmarks, improved pre-procedure planning, reduction in complications, less time spent at the bedside, and improved first-attempt success rates as advantages to using US guided placement. 

The Debrief

Are you using US in your current practice? In what capacity are you using US? What are some other potential uses for US that may help RTs add value to our practice and provide better patient outcomes? What are your opinions on training RTs to use ultrasound to assess, diagnosis and provide care? What are some barriers preventing implementation?

References

  1. Karthika, M., Wong, D., Nair, S. G., Pillai, L. V., & Mathew, C. S. (2019). Lung ultrasound: the emerging role of respiratory therapists. Respiratory Care, 64(2), 217–229. https://doi.org/10.4187/respcare.06179 
  2. Miller, A. G., & Bardin, A. J. (2016). Review of ultrasound-guided radial artery catheter placement. Respiratory Care, 61(3), 383–388. https://doi.org/10.4187/respcare.04190

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