Teleguided Point-of-Care Ultrasound for Fluid Assessment in Geriatric Inpatients Performed by Nurses and Medical Students: Prospective Observational Feasibility Study.

backgroundFluid assessment in geriatric inpatients is challenging, as clinical signs are often unreliable. Inferior vena cava (IVC) ultrasound provides a rapid, noninvasive estimation of intravascular volume. Teleguided point-of-care ultrasound (POCUS) allows examiners without prior ultrasound experience to perform scans under real-time supervision.

objectiveThis study aimed to evaluate the feasibility, accuracy, efficiency, and user satisfaction of remote-guided IVC ultrasound performed by medical students and nurses without prior ultrasound experience in a geriatric inpatient setting.

methodsThis prospective feasibility study was conducted between February and March 2025 in a geriatric inpatient ward at a German tertiary care hospital. Thirty hospitalized geriatric patients were recruited using a pragmatic convenience sampling approach on predefined study days. Each patient underwent 2 IVC ultrasound examinations (n=60) using a handheld device with TeleGuidance; one was performed by a medical student and one by a nurse. All scans were remotely supervised by an ultrasound-experienced cardiologist, who subsequently performed a third, independent IVC scan on each patient, serving as the reference standard. Examiners were 2 final-year medical students and 2 nurses, all without ultrasound experience, each performing 15 scans. Primary outcomes were technical feasibility (successful teleguidance connection), accuracy of IVC diameter measurement (≥80% within +2 mm to -2 mm), and examination duration (≤10 minutes). The secondary outcome was user satisfaction (≥75 on a 0-100 numeric rating scale).

resultsConnectivity and remote supervision were consistently stable, enabling completion of all scans (feasibility 100%). IVC visualization was successful in 90% (27/30) of cases. Accuracy was achieved in 80% (48/60; 95% CI 67-88) of scans. Mean duration was 3.3 (SD 2.0) minutes. Mean user satisfaction was 89%, with all ratings ≥85%.

conclusionsTelemedicine-guided IVC ultrasound was feasible and well accepted in this geriatric inpatient setting. Nonexpert examiners were able to obtain clinically usable measurements under remote supervision within a few minutes after minimal training. These findings suggest that teleguided POCUS is a promising approach to support task sharing in geriatric care. Further studies are needed to confirm these results and to evaluate integration into clinical practice.

trial registrationGerman Clinical Trials Register DRKS00035821; https://www.drks.de/search/de/trial/DRKS00035821/details.