Clinical Competency in Inferior Vena Cava Assessment as a Part of Nurse-Initiated Sono Triage Among Emergency Nurses: A Quasi-Experimental Study EMERGENCY NURSES' IVC SONOGRAPHY COMPETENCY

Abstract

Aim: To evaluate emergency nurses' clinical competency in Nurse-Initiated Sonography for Inferior Vena Cava (IVC) assessment before and after a structured competency-based educational intervention.

Background: Rapid assessment of haemodynamic status is fundamental in emergency care, particularly for patients presenting with trauma or suspected hypovolaemia. Inferior vena cava (IVC) ultrasonography is a focused point-of-care ultrasound technique that provides valuable information on intravascular volume status and fluid responsiveness. While IVC assessment is widely used by physicians, evidence regarding competency among emergency nurses remains limited. Nurse-Initiated Sono Triage (NISt) was developed to strengthen nurses' competency in focused ultrasound assessment during emergency triage; this study evaluated nurses' clinical competency in performing IVC assessment as a component of NISt.

Methods: A quasi-experimental one-group pre-test–post-test study was conducted among 30 emergency nurses working in the Yellow Area of the Emergency Department of a tertiary care hospital in New Delhi, India. This manuscript represents a predefined secondary analysis of a larger NISt study, focusing exclusively on IVC competency. Competency was assessed during 600 paired clinical observations using a validated observational checklist evaluating two domains – IVC diameter assessment and identification of IVC wall kissing – each scored on a five-point competency scale. Following baseline assessment, nurses underwent a structured competency-based educational programme comprising theoretical instruction, demonstration, return demonstration, and supervised bedside practice, after which competency was reassessed. Descriptive statistics and paired comparisons were used to evaluate change in competency.

Results: Baseline competency in IVC assessment was limited, with most observations demonstrating unsatisfactory performance. Following competency-based education and supervised clinical practice, competency scores improved substantially, with the majority of assessments shifting to satisfactory and good performance categories. Mean competency scores increased significantly from pre-intervention to post-intervention (p < 0.001), reflecting marked improvement in image acquisition, technical performance, and interpretation of IVC findings. The observational checklist demonstrated excellent reliability (Cohen's κ = 0.90), with expert agreement ranging from 0.86 to 0.96.

Conclusion: Emergency nurses demonstrated significant improvement in clinical competency for IVC assessment following implementation of the NISt programme. The findings support the feasibility of integrating focused IVC ultrasonography into nurse-initiated emergency assessment and highlight the potential of competency-based education to expand nursing roles in point-of-care ultrasound.