# Feasibility and clinical value of nurse-led point-of-care ultrasound screening for prethrombotic state in postoperative cardiac ICU patients: a cross-sectional study

## TL;DR

Nurse-led ultrasound screening can help detect early signs of blood clots in heart surgery ICU patients, improving early risk assessment and care.

## Contribution

Demonstrates the feasibility of nurse-led POCUS for prethrombotic state detection in postoperative cardiac ICU patients.

## Key findings

- The 'blizzard' sign was observed in 61.8% of patients, primarily in lower limb veins.
- Prolonged bed rest, elevated platelet count, and high C-reactive protein levels predicted prethrombotic state.
- Nurse-led POCUS was successfully implemented with high feasibility and diagnostic value.

## Abstract

Postoperative cardiac ICU patients are at increased risk of developing venous thromboembolism (VTE), yet early identification of prethrombotic state (PTS) remains challenging. Nurse-led point-of-care ultrasound (POCUS) offers a non-invasive, real-time tool for vascular screening that may enhance early risk stratification.

To determine the prevalence of PTS in postoperative cardiac ICU patients using a nurse-led POCUS protocol, identify associated clinical risk factors, and evaluate the feasibility and clinical value of integrating this screening model into routine nursing care within an interprofessional framework.

This cross-sectional study included 123 adult patients following cardiac surgery. ICU nurses trained in POCUS independently performed bedside color Doppler scans to detect the “blizzard” sign in lower limb veins. Demographic, clinical, and laboratory data were collected. Multivariate logistic regression was used to identify independent predictors of PTS. The nurse-led POCUS protocol was implemented collaboratively with doctors, who provided image verification and clinical oversight as needed.

The “blizzard” sign was observed in 61.8% of patients, most commonly in the popliteal and posterior tibial veins. Nine patients developed deep vein thrombosis, all of whom had prior severe, diffuse-type “blizzard” signs. Independent predictors of PTS included prolonged bed rest (OR 1.016, P = 0.031), elevated peak platelet count (OR 1.007, P = 0.041), and increased postoperative C-reactive protein levels (OR 1.015, P < 0.001). The nurse-led POCUS protocol was implemented successfully with doctor oversight and demonstrated high feasibility and diagnostic yield.

Nurse-led POCUS is a feasible, non-invasive approach for early identification of PTS in postoperative cardiac ICU patients. Embedding such screening protocols into nursing workflows may support timely thromboprophylaxis, expand nursing roles in advanced assessment, and enhance interprofessional ICU care delivery.

The online version contains supplementary material available at 10.1186/s13089-025-00459-9.