Growth Opportunity: RTs Train in Lung Ultrasound

Lung Ultrasound
Michael Terry, left, joins, from left to right, Dr. Paresh Giri, Dr. Vi Dinh, and Patrick Luna, RRT, in showing off the lung ultrasound equipment used at Loma Linda.

Getting ahead in today’s healthcare environment will require RTs to take on new skills. At Loma Linda University Medical Center in Loma Linda, CA, bedside lung ultrasound (LUS) is next on the list.

Michael Terry, BS, RRT, RPFT, CCRC, senior research coordinator in the respiratory care department, says two things came together to make it possible.

First, the department’s medical director Paresh Giri, MD, FCCP gained experience with LUS and wanted to make the tool available to RTs.

Then Richard Nelson, MD, MS, RRT-NPS, who serves as program director of the bachelor’s degree respiratory care program at Loma Linda, traveled to Paris to do a clinical rotation with Daniel Lichtenstein, MD, who developed the Bedside Lung Ultrasound in Emergency, or “BLUE,” protocol.

The BLUE protocol uses the technology to conduct a simple, goal-directed lung ultrasound examination aimed at establishing a quick differential diagnosis and institution of proper therapy.

Training underway

Both Terry and Dr. Nelson have been trained in the technology and the protocol and will begin training five additional RTs to add to the team this month.

“We chose to train RCPs for lung ultrasound because they assess and monitor lung function in our ICUs, and LUS is a valuable addition to their armamentarium,” Terry said. “After this group is fully operational, we plan to expand to include other venues such as surgical ICU and emergency medicine.”

The training is based on Dr. Lichtenstein’s BLUE protocol and includes eight hours of classroom instruction followed by six hours of clinical experiences.

Feedback will be provided by physician experts and the respiratory care educators.

The ultimate goal is to train all of the RTs in the Loma Linda department so that they can provide a comprehensive scan for all patients admitted to the ICU and prior to daily rounds.

“We will also scan the patient when we think there may be an unexplained change in lung function or to document or assess status after invasive procedures,” Terry said.

Clinical study in the works

Terry and his colleagues will conduct a study to examine the level of agreement between physician experts in LUS and the LUS-trained RTs. Dr. Nelson, who is also an AARC member, will serve as principle investigator.

“Our hypothesis is, with the training and clinical experience provided to our RCPs, they will be able to accurately acquire and interpret LUS images,” Terry said.

The study isn’t designed to assess the value that training RTs to do lung ultrasound adds to the organization, although Terry explained that it may be added to the mix in the future.

Terry says LUS is a perfect fit for the RTs at Loma Linda because they already perform comprehensive assessments on ICU patients and many times those assessments lead the physician to perform a lung ultrasound for further assessment.

“With this training, we hope to accelerate care delivery,” Terry said. “LUS will be another tool they can use to paint a more complete picture.”

A perfect match

He believes LUS is a technology that should be in the hands of other bedside RTs too.

“RCPs are ideally suited for this procedure because they are usually present for these types of patients around the clock and have the background and capacity to learn these techniques,” Terry said.

It is his hope that the study will show that RTs can provide this service both accurately and efficiently.

“If we accomplish that, we hope other departments will begin to offer this service as well,” Terry said.