Venous Excess Ultrasound
Venous Excess Ultrasound - Related Videos
05:49
Demystifying Venous Excess Ultrasound (VExUS): Image Acquisition and Interpretation
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Cited by 1 •
2025
Point-of-care ultrasound (POCUS) is often used to assess the hemodynamic circuit and detect the presence of venous congestion. The Venous Excess Ultrasound (VExUS) scoring system was developed to aid clinicians in predicting the impact of venous congestion on organ dysfunction. This article aims to describe VExUS image acquisition and interpretation.
10:45
Central Venous Catheter Insertion: Femoral Vein
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2023
Source: James W Bonz, MD, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA Central venous access is necessary in a multitude of clinical situations, including vascular access, vasopressor and caustic medication delivery, central venous pressure monitoring, volume resuscitation, total parental nutrition, hemodialysis, and frequent phlebotomy. There are three veins in the body that are accessed for central venous cannulation: the internal jugular, the subclavian, and the...
11:39
Central Venous Catheter Insertion: Internal Jugular
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2023
Source: James W Bonz, MD, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA Central venous access is necessary in a multitude of clinical situations, including vascular access, vasopressor and caustic medication delivery, central venous pressure monitoring, intravascular device delivery (pacing wires, Swann-Ganz catheters), volume resuscitation, total parental nutrition, hemodialysis, and frequent phlebotomy. Safe reliable placement of a central venous catheter (CVC) in...
01:18
Excess Reserves
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2025
Excess reserves, while often viewed as idle funds from a lending perspective, play a vital role in ensuring financial stability and managing risk—particularly during periods of economic uncertainty or regulatory change.Strategic Value Beyond LiquidityExcess reserves are not merely a liquidity buffer; they represent a deliberate strategic decision by banks. When economic conditions are stable, lending typically yields higher returns. However, during periods of financial volatility or increased...
06:45
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
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Cited by 4 •
2023
Traditionally, lower extremity deep venous thrombosis (DVT) is diagnosed by radiology-performed venous duplex ultrasound. Providers appropriately trained in focused point-of-care ultrasound (POCUS) can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. We describe the scanning technique for focused POCUS DVT lower extremity examination.
FAQs
VExUS interprets venous congestion by combining anatomical and flow information. Inferior vena cava imaging is paired with pulsed-wave Doppler assessment of hepatic, portal, and intrarenal venous blood flow. Characteristic changes across these measurements are integrated into a graded congestion score, allowing clinicians to characterize the severity of systemic venous congestion rather than relying on one ultrasound observation alone.
The Doppler components extend the assessment beyond the central venous compartment. Hepatic, portal, and intrarenal venous waveforms provide flow information from different vascular territories, while inferior vena cava imaging contributes a complementary bedside view. Considering these findings together helps connect venous congestion with its potential effects on organs, which is central to evaluating patients at risk of organ dysfunction.
Waveform changes matter because they are treated as signs of abnormal venous flow in the setting of systemic congestion. Their interpretation within the VExUS grading framework converts several ultrasound observations into a clinically usable congestion score. That score can help identify clinically significant fluid overload and support decisions about whether ongoing congestion may be contributing to organ dysfunction.
VExUS can help separate two clinically different situations: persistent venous congestion and inadequate circulating volume. This distinction is important because a patient who remains congested may need fluid removal or other hemodynamic management, while inadequate circulating volume represents a different clinical concern. The assessment therefore supports more individualized bedside decision-making rather than treating all fluid-related findings alike.
The assessment uses noninvasive point-of-care ultrasound to image the inferior vena cava and obtain pulsed-wave Doppler measurements from hepatic, portal, and intrarenal venous blood flow. Clinicians evaluate the resulting waveform characteristics together with the vena cava findings and integrate them into a graded congestion score, producing a structured bedside assessment of venous excess.
Clinical use is especially relevant when congestion may influence management, including acute heart failure, shock, and acute kidney injury. In these settings, the score can contribute to evaluating fluid status and help guide fluid removal or broader hemodynamic management. Its bedside, noninvasive format supports individualized assessment of critically ill and hospitalized patients when organ dysfunction and fluid balance are major concerns.