Transcript Inferior Vena Cava - St. Luke's Roosevelt Ultrasound Division

Sonographic Assessment of the
Inferior Vena Cava
Alexis P Langsfeld MD
Anatomy
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Anatomy
 The inferior vena cava returns blood from
the body to the right atrium
 Formed by the convergence of the illiac
veins
 Retroperitoneal
 Right of the aorta
 Normal size <2.5 cm
 Varies w respiration
Respiratory variation
 expands w/ expiration
 Contracts w/ inspiration
 Due to changing intrathoracic pressures.
IVC Anatomy
Technique
Probe Selection
 Low frequency 2-5 MHz
 Curvalinear probe
Orientation
 Measure at the subcostal window
 Adjacent to the rt atrium
 Measure just below the diaphram - about 1
cm before the hepatic viens.
 Parallel walls
Views
 Cross section
 Longitudinal
Venous abdominal anatomy
Proximal IVC
IVC Longitudinal
Aorta vs IVC
Aorta
Thick echogenic walls
Pulsatile
High flow velocity
Not compressable
No respiratory variation
IVC
Thin walls
Not pulsitile
Low flow velocity
Compressable
Respiratory variation
IVC & AORTA
Flow Velocities
 Aorta = High flow velocities
 IVC = lower flow velocities
IVC Flow
Aorta flow
Portal Vein Flow
Sagital IVC
Benefits
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Assessment of volume status
Find clots
Non-invasive
No radiation
At the bedside
CVP Assessment
Gestalt method
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IVC Collapse with inspiration
“YES / NO”
Yes - CVP approximately 8
No - CVP around 15
Right Atrial Pressures
IVC DIAMETER
CHANGE W RESP
Estimated RAP
mmHg
<1.5 small
Collapse
0-5
1.5-2.5 nl
Decrease >
50%
5-10
>2.5 nl
Decrease < 50%
10-15
>2.5 dilated
Decrease < 50%
15-20
Dilated, w/ dilated
hepatic veins
No change
>20
Research: ED Physicians Capable

Hruda, Jarslav et al. Echocardiographic Assessment of Preload Conditions Does Not
Help at the Neonatal Intensive Care Unit. American Journal of Perinatology 2003;20:297303.

Lloyd, TR. Accuracy of Central Venous Pressure Measurement From the Abdominal
Inferior Vena Cava. Pediatrics 1992; 89: 506-508

Krause, Irit et al. Inferior vena cava diameter: a useful method for estimation of fluid
status in children on haemodialysis. Nephrology Dialysis Transplantation 2001; 16:12031206.

Lyon, Matthew, MD. Sonographic measurement of the inferior vena cava as a marker of
blood loss. The American Journal of Emergency Medicine 2005; 23:45-50.
Research: CVP Assessment

Chen, Lei, Kim, Yunie, Santucci, Karen A. Use of Ultrasound
Measurement of the Inferior Vena Cava Diameter as an Objective
Tool in the Assessment of Children with Clinical Dehydration. Acad
Emerg Med 2007 14: 841-845

Krause, Irit et al. Inferior vena cava diameter: a useful method for
estimation of fluid status in children on haemodialysis. Nephrology
Dialysis Transplantation 2001; 16:1203-1206.

Lyon, Matthew, MD. Sonographic measurement of the inferior vena
cava as a marker of blood loss. The American Journal of Emergency
Medicine 2005; 23:45-50.
Conclusion
 Anatomy review
 Physiologic review
 Technical review for good IVC
measurements
 Data supports use of IVC sonography as a
rudimentary assessment of volume status
 Can use clinically to guild patient
management
References

Hruda, Jarslav et al. Echocardiographic Assessment of Preload Conditions Does Not Help at the
Neonatal Intensive Care Unit. American Journal of Perinatology 2003;20:297-303.

Lloyd, TR. Accuracy of Central Venous Pressure Measurement From the Abdominal Inferior Vena
Cava. Pediatrics 1992; 89: 506-508

Krause, Irit et al. Inferior vena cava diameter: a useful method for estimation of fluid status in
children on haemodialysis. Nephrology Dialysis Transplantation 2001; 16:1203-1206.

Lyon, Matthew, MD. Sonographic measurement of the inferior vena cava as a marker of blood loss.
The American Journal of Emergency Medicine 2005; 23:45-50.

Textbook of Cardiovascular Medicine, Topol, Califf, Lippincott Williams& Wilkins 2006

Color Duplex Sonography: Principles and Clinical Applications, Karl-Jürgen Wolf, Franz Fobbe, 2005,
p.180-195

Differential Diagnosis in Ultrasound, Gunter Schmidt, Pri, Werner, Asim Kurjak, Barbara
(CON) Beuscher-Willems, - Medical - 2006