The role of point-of-care ultrasound in the management of dialysis patients with COVID-19

Introduction: Much of the burden for management of outpatient dialysis patients with suspected or confirmed Coronavirus Disease 2019 (COVID-19) has fallen to the dialysis units Symptom recognition is not straightforward as these patients often have multiple putative etiologies for dyspnea especially given concomitant pulmonary congestion due to fluid overload In this context, point-of-care ultrasonography (POCUS), particularly lung ultrasound (LUS) is a valuable diagnostic tool for nephrologists taking care of these patients POCUS is free of ionizing radiation, can be performed at the bedside, and has comparable diagnostic accuracy to chest CT scan for most lung pathologies We present a case study to illustrate the role of POCUS in dialysis patients Case Description: A 79-year-old woman with a history of ESKD on maintenance hemodialysis was found to be hypoxemic with an oxygen saturation of 90% on room air Bedside LUS demonstrated patchy areas of pleural thickening and irregularity as well as confluent B-lines and scattered consolidations consistent with viral pneumonia [Figure] Focused cardiac US did not reveal any overt signs of fluid overload She tested positive for COVID-19 and improved with supportive care She continued to receive dialysis on a separate shift for COVID-19 positive patients Discussion: In addition to aiding in diagnosis, POCUS limits staff exposure to the virus during transportation and avoids the downtime for radiology room decontamination unlike CT Most handheld US devices can be completely encased in a standard plastic transducer cover that can be discarded after each use We propose that dialysis units adopt LUS as a bedside tool to diagnose and monitor the extent of pulmonary involvement in patients with COVID-19 and differentiate from other causes of dyspnea CT scan can be reserved for those with equivocal LUS findings or underlying chronic lung disease that interferes with interpretation