Nurse-led inferior vena cava assessment using handheld ultrasound within a cardiologist-supported home-care workflow

Volume assessment in older adults receiving home-based care is challenging because body weight, edema, and symptoms may be insufficient indicators, particularly in patients with cognitive impairment. We describe a 95-year-old woman with heart failure with preserved ejection fraction, severe tricuspid regurgitation, atrial fibrillation, and dementia. Trained visiting nurses acquired standardized inferior vena cava (IVC) images during home visits and shared them with a cardiologist through a secure cloud-based platform. At the initial assessment, the maximum IVC diameter was 19.3 mm and the IVC collapsibility index was 29%; at 3 weeks, these values were 11.0 mm and 54.5%, respectively. Because IVC findings alone cannot establish volume status, they were interpreted alongside weight loss and reduced skin turgor, and oral fluid intake was encouraged based on the overall clinical assessment. Follow-up laboratory data were unavailable, and hydration status could not be objectively confirmed. This case illustrates the feasibility of a cardiologist-supported home-care workflow integrating nurse-performed IVC assessment and remote cardiologist review. Its clinical utility requires further evaluation.