IVC ultrasound: Difference between revisions
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[[Category:Ultrasound]] |
Revision as of 15:44, 1 November 2015
Background
- Though contriversal, IVC measurement by ultrasound can estimate volume status and fluid responsiveness
- Measure both absolute diameter of IVC and percent collapse during inspiration of spontaneously breathing patients
- Can use as a dynamic assessment after intervention (giving fluids)
- Unclear if applicable to intubated patients
Technique
- Use curvilinear (abdominal) probe or phased array (cardiac) probe
- In subxyphoid cardiac view (epigastric), fan probe laterally to view the IVC draining into the right atrium
- may start with subxyphoid view, place right atrium in center of screen and rotate probe 90 degrees clockwise to find IVC
- Use M-mode to measure IVC collapse during inspiration or estimation can be made in 2D with IVC in longitudinal axis
Measurements
Correlations Between IVC Size and CVP[3]
IVC (cm) | Respiratory Change | CVP (cm H2O) |
---|---|---|
<1.5 | Total collapse | 0-5 |
1.5-2.5 | >50% collapse | 6-10 |
1.5-2.5 | <50% collapse | 11-15 |
>2.5 | <50% collapse | 16-20 |
>2.5 | No change | >20 |
Measure 2cm from IVC/RA junction or 1cm from IVC/hepatic vein junction
Classic Ultrasound Findings For Critically Ill Patients
Disease | IVC | Cardiac | Lung (Phased Array) | Lung (Linear) |
---|---|---|---|---|
MI | ↑ | Focal WMA Mod/Poor squeeze |
NL or B-lines | Sliding |
Tamponade | ↑ | RA collapse with filling RV collapse with filling |
NL | Sliding |
PTX | ↑ | NL or Hyperdynamic | Lung point Consolidated lung |
Absent lung sliding |
Sepsis | ↓ | Hyperdynamic squeeze | NL (see pneumonia) | Sliding |
Pneumonia | NL or ↓ | Hyperdynamic squeeze | Unilateral B-lines | Sliding |
Decompensated HF | ↑ | Mod/Poor squeeze | Bilateral B-lines | Sliding |
PE | ↑ | RV > LV McConnell's sign |
NL or Unilateral B-lines | Sliding |
See Also
References
- ↑ Dipti A, et al. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. AJEM. 2012; 30:1414-1419.
- ↑ Zhang Z, et al. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasound Med Biol. 2014. May; 40(5):845-53.
- ↑ Goldflam K, et al. Focus on: Inferior vena cava ultrasound. ACEP News. June 2011.