Tips for Developing your confidence in Small Animal Point-Of-Care (POCUS) ultrasound and becoming an ultrasound leader
Developing competency and confidence in ultrasound as a vet nurse can seem like a daunting task. Our experience has highlighted key issues that are encountered by vets and vet nurses alike, and we have collated some simple steps that we believe will greatly expediate your development into an ultrasound leader.
- Get an honest assessment of your equipment.
There is no point wasting precious time and energy trying to improve your ultrasound skills if the machine in your practice is not fit for purpose. The banged up old sheep scanner, or the thirty year-old gargantuan with an endo-cavity probe donated by the local gynaecologist, are not doing you or the practice’s standard of care any favours. Your ability to perform point-of-care (POCUS) scans is directly related to the quality of the image the machine is able to produce. If you can’t see it clearly, how can you detect free fluid with confidence?
Action: Reach out to your ultrasound equipment sales representative or applications specialist at IMV. They will be more than happy to assess the practice’s needs, and can give advice regarding existing equipment. Ask for demos on all the systems you are looking at to enable you to make the most informed decision, and consider whether a hand-held scanner like the GE VSCAN Air might aid your nursing team to perform POCUS scans in triage consults and kennel-side.
- Learn how to use your machine, including basic image optimisation.
It’s not uncommon to hear veterinary staff saying that they are “afraid to touch buttons in case they break something” when discussing their ultrasound machine. When in doubt, just remember that ultimately it’s just a computer with a funny-looking keyboard… and there is nothing you can press that can’t be reset!
Basic image optimisation should be included in learning how to use your machine, and this is an important and often-overlooked fundamental skill. An experienced sonographer will optimise their image throughout a scan, because they know that their ability to perform an accurate and repeatable POCUS scan and recognize abnormalities is directly associated with their ability to make the image as clear as it can be.
Just as using incorrect exposure settings when taking a radiograph will hamper your ability to make a diagnosis, so will poor image optimisation hamper your ability to perform a POCUS scan, even with the fanciest of equipment.
Action: If you haven’t done so already, ask your account manager at IMV to provide a training session with your machine, or check out our fantastic learning resources online, and any guides which are available for your ultrasound model. You can then sit and dedicate some time to familiarising yourself with your machine’s functionality.
- Go on a course!
Courses are really beneficial because not only do they cover fundamentals such as image optimisation, machine and patient preparation and artefacts, but they also equip you with systematic techniques to use when performing both thoracic and abdominal POCUS scans. This helps you to ascertain more confidently whether you have examined all the appropriate areas thoroughly. Additionally, they will also provide insight into recognising free fluid, abnormal lung and free gas, and how these pathological conditions differ from the normal ultrasonographic appearance of the anatomy.
Action: In addition to our range of posters, guides, webinars and journal clubs, IMV imaging provide a range of courses specifically designed for vet nurses; including online and in-person options. Check out our online learning platform here where you can register for upcoming courses around the country.
- Scan, scan, scan… whilst creating an environment more conducive to your learning.
Scan as many patients as you can. In the beginning this might involve scanning your own pets repeatedly, or trying your hand at one or two areas at the start or end of a vet’s diagnostic scan. As a beginner, it can be hard to put yourself forward to triage or track a case using ultrasonography, but with time, observation and repetition, your confidence will grow quickly. Other vet nurses around you will be inspired and empowered to observe and then learn through doing, and your nursing team’s contribution to the workup and monitoring of cases will be invaluable.
Sedation and analgesia are the patient’s and your friend. Many of the animals you are triaging or tracking using abdominal or thoracic POCUS scans have a degree of discomfort, and they are likely to be ill and anxious. If the patient is struggling, boarding their abdominal musculature or resisting the touch of the probe, your job of examining certain areas (particularly in the cranial abdomen) becomes unnecessarily difficult, as well as unpleasant and stressful for the patient. Remember to ask your vets to assess the patients for analgesia as needed, and ensure that sedated patients are properly monitored.
Action: Discuss your own and the nursing team’s scanning goals with other team members and agree on a system or protocol that works for everyone. For example, consider whether to include POCUS scanning for inpatient checks after abdominal surgeries or when patients are being treated for conditions like acute congestive heart failure. Don’t forget that when you upskill yourself, this directly benefits the practice by improving the standard of care and increasing income, which can outweigh any short-term inconvenience of taking longer with scans when you are still a beginner.
- Find a mentor, keep learning.
Some of you will be lucky enough to have a colleague in your practice who is able to mentor and oversee your scanning journey. Others might not be so lucky and will need to self-teach, or become that mentor. Typically, after attending a course, we see a sharp learning curve whereby vet nurses who are keen to learn how to perform POCUS scans quickly master the technical skills, and can rapidly and confidently perform thoracic and abdominal POCUS scans in stressful situations, with any variation of patient recumbency and for a wide range of tracking scenarios. This vet nurse can then become a mentor for the rest of the veterinary team; whereby the team can double check themselves and the conclusions they are drawing from their scans, allowing them to keep growing and improving their knowledge. If this is you, put yourself in the best place you can, by gathering resources around you such as good quality ultrasound textbooks, relevant professional accounts on social media, attending webinars and courses, and reading articles relevant to your topic of interest.
Action: If you are not blessed with a mentor in practice, reach out to others in the veterinary community; specialist or special-interest colleagues, course teachers, social media-savvy professionals, and clever friends. BUT, (as a friendly warning), in order to get the most out of your mentorship and maintain a good relationship with your mentor, avoid sending blurry phone videos and skewed photos of an ultrasound screen, ensure you are performing complete and systematic POCUS scans, learn the correct terminology to describe abnormalities that you see, and ensure your image optimisation skills are very good. By doing so you will be able to capture high quality stills and video clips, export the files, and share them directly. Just like you wouldn’t refer a case without a history, be a professional when asking for assistance with your scans.
Although being confident and competent in ultrasound is the goal. It is important to add that just like every aspect of veterinary practice, you need to recognise your own limitations. If you are out of your depth, always refer to a vet as appropriate! Remember that vet nurses are not allowed to diagnose via ultrasound, and findings should always be reported to the vet surgeon in charge of the case.
Get an honest assessment of your equipment.
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