Name: Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava (Video) | JoVE Journal
Uploaded: 2023-01-13T14:50:00.000+00:00
Duration: 6 min 59 s
Description: Learn a systematic ultrasound approach for inferior vena cava assessment to evaluate volume status in shock patients. This protocol minimizes common pitfalls and prioritizes technically achievable views for accurate clinical interpretation.

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5 minutes

The authors have no acknowledgments.

All procedures performed in the studies involving human participants were conducted in accordance with the ethical standards of the Duke University Health System Institutional Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The protocol was performed using input from several peer-reviewed papers in the academic literature2,13,14,15. Imaging was performed on the authors themselves for the normal images and as part of routine educational ultrasound scans done for teaching purposes for the positive images, with preceding verbal consent obtained as per institutional standards. The patients were selected based on certain criteria. Specifically, the inclusion criterion was any patient with hypotension, and the exclusion criterion was patient refusal to undergo an ultrasound exam.
1. Safety procedures
<ol>
	<li>Utilize nonsterile nitrile or latex gloves depending on the patient&#39;s allergies. Additional safety precautions may be required based on the clinical context. Please refer to the respective institution&#39;s infection control policies, and follow any precautions in place.</li>
</ol>
2. Probe selection
<ol>
	<li>For infants (i.e., children younger than 1 year of age), perform the sonographic evaluation of the IVC with either a low-frequency or high-frequency (&#62;5 MHz) ultrasound transducer, depending on the infant&#39;s body size. 
	&#8203;NOTE: IVC evaluation in infants is a specialized pediatric topic beyond the scope of this review. The remainder of this review solely focuses on imaging the IVC in individuals over 1 year of age.</li>
	<li>For individuals over 1 year of age, visualize the IVC with any low-frequency (&#8804;5 MHz) ultrasound transducer, such as a linear phased-array sector arc probe or curvilinear probe. 
	NOTE: The linear phased-array sector arc probe is commonly referred to as a phased-array probe. This term is misleading, since all modern ultrasound transducers use phasing to steer the ultrasound beam16,17. However, for the sake of brevity, throughout this review, we will use the term phased-array probe instead of linear phased-array sector arc probe.
	<ol>
		<li>The phased-array probe is the optimal probe for both main types of external cardiac ultrasound: transthoracic echocardiography (TTE) and focused cardiac ultrasound (FoCUS)18. When performing either TTE or FoCUS to evaluate the heart, continue using the phased-array transducer for the IVC portion of each exam rather than switching to another low-frequency probe.</li>
	</ol>
	</li>
</ol>
3. Machine preset
<ol>
	<li>Set the machine to the cardiology convention by using the Cardiac Preset function, which sets the indicator to the left of the screen. Set the screen refresh rate to &#62;20 Hz. 
	NOTE: The IVC evaluation can be performed in the Abdominal Mode. However, for the same points mentioned in step 2.2.1, it is far more convenient to utilize the same presets for both a FoCUS exam and a POCUS IVC exam.</li>
	<li>Set the mode to B-Mode (2-dimensional grayscale). Set the depth to 6-20 cm, depending on the depth of the IVC in each patient.</li>
</ol>
4. Scanning technique
<ol>
	<li>Apply ultrasound gel to the transducer.</li>
	<li>Obtain the anterior IVC short-axis (ANT IVC SAX) view.
	<ol>
		<li>Position the patient in the supine position with both hips flexed, if tolerated by the patient.</li>
		<li>Place the ultrasound probe centered on the patient&#39;s anterior midline just caudal to the xiphoid process in the coronal plane, with the transducer indicator mark pointing toward the patient&#39;s left (Figure 1).</li>
		<li>Adjust the depth so that the IVC and aorta appear in the middle third of the screen and the spine is visible (Video 1).</li>
		<li>For setting the axis, fan the ultrasound beam cranially or caudally until both the IVC and the abdominal aorta appear in the short-axis cross-section as rounded structures (Video 1).</li>
		<li>Decrease the gain until the blood in the IVC is either completely black or just a few specks of grey are visible (Video 1).</li>
		<li>Once all the settings are done, click on Acquire.</li>
	</ol>
	</li>
	<li>Obtain the anterior IVC long-axis (ANT IVC LAX) view.
	<ol>
		<li>Position the patient in the supine position with both hips flexed, if tolerated by the patient.</li>
		<li>Position the probe for obtaining the ANT IVC SAX view as described in step 4.2, center the view on the IVC, and rotate the ultrasound probe 90&#176; counterclockwise, without translating the probe, such that the probe&#39;s indicator faces cranially at the end of the rotation (Figure 2).</li>
		<li>Adjust the depth so that the IVC appears in the middle third of the screen and the liver tissue is visible deeper than the IVC (Video 2).</li>
		<li>For setting the axis, fan the ultrasound beam toward the patient&#39;s left or right until the IVC appears as a rectangular, intrahepatic structure spanning from cranial to caudal on the screen. (Video 2).</li>
		<li>Decrease the gain until the blood in the IVC is either completely black or just a few specks of grey are visible (Video 2).</li>
		<li>Once all the settings are done, click on Acquire.</li>
		<li>Optional: Quantify the IVC anterior-to-posterior (AP) diameter (Figure 3).
		<ol>
			<li>With a live image of the IVC optimized as per step 4.3.6, click on Freeze. Click on Caliper or Measure, depending on the machine&#39;s measurement button.</li>
			<li>Move the trackball to the anterior wall of the IVC approximately 1-2 cm caudal from the hepatic vein confluence. Click on Select.</li>
			<li>Move the trackball to the posterior wall of the IVC opposite the point in step 4.3.7.2, such that the line between the two points is roughly perpendicular to the long axis of the IVC. Click on Select, and then click on Acquire.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Obtain the right lateral IVC long-axis (RL IVC LAX) view.
	<ol>
		<li>Position the patient in the supine position with the legs flat and the right arm moved away from the patient&#39;s side, either overhead or outstretched laterally, so as to allow access to the right flank.</li>
		<li>Place the probe transducer in the coronal plane with the indicator pointing cranially in the sixth or seventh right intercostal space just anterior to the right mid-axillary line (Figure 4).</li>
		<li>Adjust the depth so that the IVC appears in the middle third of the screen and the liver tissue is visible deeper than the IVC (Video 3).</li>
		<li>For setting the axis, fan the ultrasound beam anteriorly or posteriorly until the IVC is visualized as a rectangular, intrahepatic structure spanning from cranial to caudal on the screen (Video 3).</li>
		<li>Decrease the gain until the blood in the IVC is either completely black or just a few specks of grey are visible (Video 3). Click on Acquire.</li>
	</ol>
	</li>
	<li>Obtain the right lateral IVC short-axis (RL IVC SAX) view.
	<ol>
		<li>Continue positioning the patient supine with the legs flat and the right arm moved away from the patient&#39;s side, either overhead or outstretched laterally, so as to allow access to the right flank.</li>
		<li>Continue positioning the probe in the position used for obtaining the RL IVC LAX view (see step 4.4), center the view on the IVC, and rotate the ultrasound probe 90&#176; clockwise, without translating the probe, such that the probe&#39;s indicator faces anteriorly at the end of the rotation (Figure 5).</li>
		<li>Adjust the depth so that the IVC appears in the middle third of the screen and the liver tissue, aorta, and spine are all visible deeper than the IVC (Video 4).</li>
		<li>For setting the axis, fan the ultrasound beam cranially or caudally until the IVC and abdominal aorta are visible in the short-axis view as rounded structures (Video 4).</li>
		<li>Decrease the gain until the blood in the IVC is either completely black or just a few specks of grey are visible (Video 4). Click on Acquire.</li>
	</ol>
	</li>
</ol>

<ol><li>Hashim, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+utility+of+point+of+care+ultrasonography+%28POCUS%29%5BTitle%5D)+AND+%22Annals+of+Medicine+and+Surgery%22%5BJournal%5D)">The utility of point of care ultrasonography (POCUS).</a> Annals of Medicine and Surgery. 71, 102982(2021).</li>
<li>Finnerty, N. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Inferior+vena+cava+measurement+with+ultrasound%3A+What+is+the+best+view+and+best+mode%5BTitle%5D)+AND+%22The+Western+Journal+of+Emergency+Medicine%22%5BJournal%5D)">Inferior vena cava measurement with ultrasound: What is the best view and best mode.</a> The Western Journal of Emergency Medicine. 18 (3), 496-501 (2017).</li>
<li>Aslan, Y., Arslan, G., Saracoglu, K. T., Eler Cevik, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+effect+of+ultrasonographic+measurement+of+vena+cava+inferior+diameter+on+the+prediction+of+post-spinal+hypotension+in+geriatric+patients+undergoing+spinal+anaesthesia%5BTitle%5D)+AND+%22International+Journal+of+Clinical+Practice%22%5BJournal%5D)">The effect of ultrasonographic measurement of vena cava inferior diameter on the prediction of post-spinal hypotension in geriatric patients undergoing spinal anaesthesia.</a> International Journal of Clinical Practice. 75 (10), 14622(2021).</li>
<li>Vander Mullen, J., Wise, R., Vermeulen, G., Moonen, P. J., Malbrain, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Assessment+of+hypovolaemia+in+the+critically+ill%5BTitle%5D)+AND+%22Anaesthesiology+Intensive+Therapy%22%5BJournal%5D)">Assessment of hypovolaemia in the critically ill.</a> Anaesthesiology Intensive Therapy. 50 (2), 141-149 (2018).</li>
<li>Orso, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Accuracy+of+ultrasonographic+measurements+of+inferior+vena+cava+to+determine+fluid+responsiveness%3A+A+systematic+review+and+meta-analysis%5BTitle%5D)+AND+%22Journal+of+Intensive+Care+Medicine%22%5BJournal%5D)">Accuracy of ultrasonographic measurements of inferior vena cava to determine fluid responsiveness: A systematic review and meta-analysis.</a> Journal of Intensive Care Medicine. 35 (4), 354-363 (2020).</li>
<li>Caplan, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Measurement+site+of+inferior+vena+cava+diameter+affects+the+accuracy+with+which+fluid+responsiveness+can+be+predicted+in+spontaneously+breathing+patients%3A+A+post+hoc+analysis+of+two+prospective+cohorts%5BTitle%5D)+AND+%22Annals+of+Intensive+Care%22%5BJournal%5D)">Measurement site of inferior vena cava diameter affects the accuracy with which fluid responsiveness can be predicted in spontaneously breathing patients: A post hoc analysis of two prospective cohorts.</a> Annals of Intensive Care. 10 (1), 168(2020).</li>
<li>Griffin, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Inferior+vena+cava+diameter+measurement+provides+distinct+and+complementary+information+to+right+atrial+pressure+in+acute+decompensated+heart+failure%5BTitle%5D)+AND+%22Journal+of+Cardiac+Failure%22%5BJournal%5D)">Inferior vena cava diameter measurement provides distinct and complementary information to right atrial pressure in acute decompensated heart failure.</a> Journal of Cardiac Failure. 28 (7), 1217-1221 (2022).</li>
<li>Mugloo, M. M., Malik, S., Akhtar, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Echocardiographic+inferior+vena+cava+measurement+as+an+alternative+to+central+venous+pressure+measurement+in+neonates%5BTitle%5D)+AND+%22Indian+Journal+of+Pediatrics%22%5BJournal%5D)">Echocardiographic inferior vena cava measurement as an alternative to central venous pressure measurement in neonates.</a> Indian Journal of Pediatrics. 84 (10), 751-756 (2017).</li>
<li>Namendys-Silva, S. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Usefulness+of+ultrasonographic+measurement+of+the+diameter+of+the+inferior+vena+cava+to+predict+responsiveness+to+intravascular+fluid+administration+in+patients+with+cancer%5BTitle%5D)+AND+%22Proceedings%22%5BJournal%5D)">Usefulness of ultrasonographic measurement of the diameter of the inferior vena cava to predict responsiveness to intravascular fluid administration in patients with cancer.</a> Proceedings. 29 (4), 374-377 (2016).</li>
<li>Via, G., Tavazzi, G., Price, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Ten+situations+where+inferior+vena+cava+ultrasound+may+fail+to+accurately+predict+fluid+responsiveness%3A+A+physiologically+based+point+of+view%5BTitle%5D)+AND+%22Intensive+Care+Medicine%22%5BJournal%5D)">Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: A physiologically based point of view.</a> Intensive Care Medicine. 42 (7), 1164-1167 (2016).</li>
<li>Lee, C. W., Kory, P. D., Arntfield, R. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Development+of+a+fluid+resuscitation+protocol+using+inferior+vena+cava+and+lung+ultrasound%5BTitle%5D)+AND+%22Journal+of+Critical+Care%22%5BJournal%5D)">Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound.</a> Journal of Critical Care. 31 (1), 96-100 (2016).</li>
<li>Ruge, M., Marhefka, G. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((IVC+measurement+for+the+noninvasive+evaluation+of+central+venous+pressure%5BTitle%5D)+AND+%22Journal+of+Echocardiography%22%5BJournal%5D)">IVC measurement for the noninvasive evaluation of central venous pressure.</a> Journal of Echocardiography. 20 (3), 133-143 (2022).</li>
<li>Privratsky, J. R., Schroder, V. T., Hashmi, N., Bronshteyn, Y. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Initial+evaluation+for+low-pressure+cardiac+tamponade+using+focused+cardiac+ultrasound%5BTitle%5D)+AND+%22A%26A+Practice%22%5BJournal%5D)">Initial evaluation for low-pressure cardiac tamponade using focused cardiac ultrasound.</a> A&A Practice. 11 (12), 356-358 (2018).</li>
<li>Rudski, L. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Guidelines+for+the+echocardiographic+assessment+of+the+right+heart+in+adults%3A+a+report+from+the+American+Society+of+Echocardiography+endorsed+by+the+European+Association+of+Echocardiography%2C+a+registered+branch+of+the+European+Society+of+Cardiology%2C+and+the+Canadian+Society+of+Echocardiography%5BTitle%5D)+AND+%22Journal+of+the+American+Society+of+Echocardiography%22%5BJournal%5D)">Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.</a> Journal of the American Society of Echocardiography. 23 (7), 685-713 (2010).</li>
<li>Blehar, D. J., Resop, D., Chin, B., Dayno, M., Gaspari, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Inferior+vena+cava+displacement+during+respirophasic+ultrasound+imaging%5BTitle%5D)+AND+%22Critical+Ultrasound+Journal%22%5BJournal%5D)">Inferior vena cava displacement during respirophasic ultrasound imaging.</a> Critical Ultrasound Journal. 4 (1), 18(2012).</li>
<li>Kisslo, J., vonRamm, O. T., Thurstone, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Cardiac+imaging+using+a+phased+array+ultrasound+system.+II.+Clinical+technique+and+application%5BTitle%5D)+AND+%22Circulation%22%5BJournal%5D)">Cardiac imaging using a phased array ultrasound system. II. Clinical technique and application.</a> Circulation. 53 (2), 262-267 (1976).</li>
<li>vonRamm, O. T., Thurstone, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Cardiac+imaging+using+a+phased+array+ultrasound+system.+I.+System+design%5BTitle%5D)+AND+%22Circulation%22%5BJournal%5D)">Cardiac imaging using a phased array ultrasound system. I. System design.</a> Circulation. 53 (2), 258-262 (1976).</li>
<li>Via, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((International+evidence-based+recommendations+for+focused+cardiac+ultrasound%5BTitle%5D)+AND+%22Journal+of+the+American+Society+of+Echocardiography%22%5BJournal%5D)">International evidence-based recommendations for focused cardiac ultrasound.</a> Journal of the American Society of Echocardiography. 27 (7), 1-33 (2014).</li>
<li>Bhardwaj, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Combination+of+inferior+vena+cava+diameter%2C+hepatic+venous+flow%2C+and+portal+vein+pulsatility+index%3A+Venous+excess+ultrasound+score+%28VEXUS+score%29+in+predicting+acute+kidney+injury+in+patients+with+cardiorenal+syndrome%3A+A+prospective+cohort+study%5BTitle%5D)+AND+%22Indian+Journal+of+Critical+Care+Medicine%22%5BJournal%5D)">Combination of inferior vena cava diameter, hepatic venous flow, and portal vein pulsatility index: Venous excess ultrasound score (VEXUS score) in predicting acute kidney injury in patients with cardiorenal syndrome: A prospective cohort study.</a> Indian Journal of Critical Care Medicine. 24 (9), 783-789 (2020).</li>
<li>Klein, A. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((American+Society+of+Echocardiography+clinical+recommendations+for+multimodality+cardiovascular+imaging+of+patients+with+pericardial+disease%3A+Endorsed+by+the+Society+for+Cardiovascular+Magnetic+Resonance+and+Society+of+Cardiovascular+Computed+Tomography%5BTitle%5D)+AND+%22Journal+of+the+American+Society+of+Echocardiography%22%5BJournal%5D)">American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: Endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography.</a> Journal of the American Society of Echocardiography. 26 (9), 965-1012 (2013).</li>
<li>Au, A. K., Matthew Fields, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Ultrasound+measurement+of+inferior+vena+cava+collapse+predicts+propofol+induced+hypotension%5BTitle%5D)+AND+%22American+Journal+of+Emergency+Medicine%22%5BJournal%5D)">Ultrasound measurement of inferior vena cava collapse predicts propofol induced hypotension.</a> American Journal of Emergency Medicine. 35 (3), 508-509 (2017).</li>
<li>Szabó, M., Bozó, A., Darvas, K., Horváth, A., Iványi, Z. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Role+of+inferior+vena+cava+collapsibility+index+in+the+prediction+of+hypotension+associated+with+general+anesthesia%3A+An+observational+study%5BTitle%5D)+AND+%22BMC+Anesthesiology%22%5BJournal%5D)">Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: An observational study.</a> BMC Anesthesiology. 19 (1), 139(2019).</li>
<li>Chaudhry, S. R., Nahian, A., Chaudhry, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Anatomy%2C+Abdomen+and+Pelvis%2C+Pelvis%5BTitle%5D)+AND+%22StatPearls%22%5BJournal%5D)">Anatomy, Abdomen and Pelvis, Pelvis.</a> StatPearls. , StatPearls Publishing. Treasure Island, FL. (2022).</li>
<li>Abdomen. POCUSMedEd. , Available from: 
 <a target="_blank" href="https://www.pocusmeded.com/abdominal">https://www.pocusmeded.com/abdominal</a> (2022).</li>
<li>Do not mistake aorta for the IVC. NephroPOCUS. , Available from: 
 <a target="_blank" href="https://nephropocus.com/2020/05/14/do-not-mistake-aorta-for-the-ivc/">https://nephropocus.com/2020/05/14/do-not-mistake-aorta-for-the-ivc/</a> (2022).</li>
<li>Pinsky, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Cardiopulmonary+interactions%3A+Physiologic+basis+and+clinical+applications%5BTitle%5D)+AND+%22Annals+of+the+American+Thoracic+Society%22%5BJournal%5D)">Cardiopulmonary interactions: Physiologic basis and clinical applications.</a> Annals of the American Thoracic Society. 15, Suppl 1 45-48 (2018).</li>
<li>Levitov, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Guidelines+for+the+appropriate+use+of+bedside+general+and+cardiac+ultrasonography+in+the+evaluation+of+critically+ill+patients-Part+II%3A+Cardiac+ultrasonography%5BTitle%5D)+AND+%22Critical+Care+Medicine%22%5BJournal%5D)">Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-Part II: Cardiac ultrasonography.</a> Critical Care Medicine. 44 (6), 1206-1227 (2016).</li>
<li>Kaptein, M. J., Kaptein, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Inferior+vena+cava+collapsibility+index%3A+Clinical+validation+and+application+for+assessment+of+relative+intravascular+volume%5BTitle%5D)+AND+%22Advances+in+Chronic+Kidney+Disease%22%5BJournal%5D)">Inferior vena cava collapsibility index: Clinical validation and application for assessment of relative intravascular volume.</a> Advances in Chronic Kidney Disease. 28 (3), 218-226 (2021).</li>
<li>Wallace, D. J., Allison, M., Stone, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Inferior+vena+cava+percentage+collapse+during+respiration+is+affected+by+the+sampling+location%3A+An+ultrasound+study+in+healthy+volunteers%5BTitle%5D)+AND+%22Academic+Emergency+Medicine%22%5BJournal%5D)">Inferior vena cava percentage collapse during respiration is affected by the sampling location: An ultrasound study in healthy volunteers.</a> Academic Emergency Medicine. 17 (1), 96-99 (2010).</li>
<li>Yamaguchi, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Ultrasound+assessment+of+the+inferior+vena+cava+in+children%3A+A+comparison+of+sub-xiphoid+and+right+lateral+coronal+views%5BTitle%5D)+AND+%22Journal+of+Clinical+Ultrasound%22%5BJournal%5D)">Ultrasound assessment of the inferior vena cava in children: A comparison of sub-xiphoid and right lateral coronal views.</a> Journal of Clinical Ultrasound. 50 (4), 575-580 (2022).</li>
<li>Yamanoglu, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+value+of+the+inferior+vena+cava+ultrasound+in+the+decision+to+hospitalise+in+patients+with+acute+decompensated+heart+failure%3B+The+best+sonographic+measurement+method%5BTitle%5D)+AND+%22Acta+Cardiologica%22%5BJournal%5D)">The value of the inferior vena cava ultrasound in the decision to hospitalise in patients with acute decompensated heart failure; The best sonographic measurement method.</a> Acta Cardiologica. 76 (3), 245-257 (2021).</li>
<li>Kulkarni, A. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Agreement+between+inferior+vena+cava+diameter+measurements+by+subxiphoid+versus+transhepatic+views%5BTitle%5D)+AND+%22Indian+Journal+of+Critical+Care+Medicine%22%5BJournal%5D)">Agreement between inferior vena cava diameter measurements by subxiphoid versus transhepatic views.</a> Indian Journal of Critical Care Medicine. 19 (12), 719-722 (2015).</li>
<li>De Backer, D., Vincent, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Should+we+measure+the+central+venous+pressure+to+guide+fluid+management%3F+Ten+answers+to+10+questions%5BTitle%5D)+AND+%22Critical+Care%22%5BJournal%5D)">Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions.</a> Critical Care. 22 (1), 43(2018).</li>
</ol>

The authors have nothing to disclose.

Even when properly imaged, information garnered from the IVC should not be the sole data point used for guiding treatment. The exact same IVC size and respirophasic changes can be seen in both normal states and in pathologic conditions. Therefore, the clinical context is critically important for guiding how to interpret the IVC data. Further, when using ultrasound to assess a patient&#39;s intravascular volume status, the published literature is mixed as to what thresholds of IVC size and respirophasic change accurately ...

Over the last several decades, the accessibility of point-of-care ultrasound (POCUS) has increased dramatically. Providers across medical disciplines can now integrate POCUS into their bedside exams and more readily identify important contributors to patients&#39; conditions1. For example, in acute care settings, one of the most important areas of focus is the assessment and management of volume status2. Inadequate fluid resuscitation can result in tissue hypoperfusion, end-organ dysfunction, and severe acid-base abnormalities. However, overzealous fluid administration is associated with worsened mortality3. The determination of volume status has primarily been accomplished using the combination&#160;of physical exam findings and dynamic hemodynamic measures, including pulse pressure variation, central venous pressure, and/or fluid challenges via either passive leg-raise testing or intravenous fluid boluses4. With the growing availability of POCUS devices, some providers are seeking to use ultrasound imaging to supplement these measures5. The sonographic assessment of the anterior-to-posterior dimension of the IVC and the respirophasic change in that dimension can assist in the assessment of right atrial pressure and, possibly, intravascular volume status6,7,8,9.
Notably, however, the relationship between IVC parameters (i.e., size and respirophasic change) and volume responsiveness is distorted in many common situations, including but not limited to, the following: (1) passively ventilated patients receiving either high positive end-expiratory pressure (PEEP) or low tidal volumes; (2) spontaneously breathing patients making either small or large respiratory effort; (3) lung hyperinflation; (4) conditions impairing venous return (e.g., right ventricular dysfunction, tension pneumothorax, cardiac tamponade, etc.); and (5) increased abdominal compart pressure10.
While the utility of IVC sonography as a standalone measure for assessing the intravascular volume status is debated5,10,11,12, there is no debate about the fact that its use as a diagnostic tool requires imaging in standardized ways and the ability to utilize alternative views when a single vantage point proves to be inadequate2. Toward this end, this manuscript defines the four sonographic views of the IVC, illustrates common sonographic pitfalls and how to avoid them, and provides examples of both typical and extreme IVC sonographic states. There are four views in which the IVC can be adequately visualized by transabdominal sonography: anterior short-axis, anterior long-axis, right lateral long-axis, and right lateral short-axis. The protocol below describes a standardized method of image acquisition.

<table><tbody><tr><td>Edge 1 ultrasound machine</td><td>SonoSite</td><td>n/a</td><td>Used to obtain all adequate and inadequate images/clips</td></tr></tbody></table>

image acquisition method for the sonographic assessment of the inferior vena cava

Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava

Over the past several decades, clinicians have incorporated several applications of diagnostic point-of-care ultrasound (POCUS) into medical decision-making. Among the applications of POCUS, imaging the inferior vena cava (IVC) is practiced by a wide variety of specialties, such as nephrology, emergency medicine, internal medicine, critical care, anesthesiology, pulmonology, and cardiology. Although each specialty uses IVC data in slightly different ways, most medical specialties, at minimum, attempt to use IVC data to make predictions about intravascular volume status. While the relationship between IVC sonographic data and intravascular volume status is complex and highly context-dependent, all clinicians should collect the sonographic data in standardized ways to ensure repeatability. This paper describes standardized IVC image acquisition including patient positioning, transducer selection, probe placement, image optimization, and the pitfalls and limitations of IVC sonographic imaging.&#160;This paper also describes the commonly performed anterior IVC long-axis view and three other views of the IVC that can each provide helpful diagnostic information when the anterior long-axis view is difficult to obtain or interpret.

Adequate exam 
There is no single caliber or respirophasic behavior of the IVC that can be considered universally normal in all circumstances. For instance, the IVC seen in Videos 1-4 and Figure 3 was imaged in a healthy, hydrated male experiencing no acute illness. However, notably, this patient's "normal" IVC has a relatively large AP diameter, &gt;2 cm in the ANT IVC LAX view, and shows minimal respirophasic change. Th...

Point-of-care ultrasound evaluation of the inferior vena cava (IVC) is commonly utilized to identify, among other things, the volume status. Imaging should be performed systematically to ensure repeatability. This manuscript reviews the methods and pitfalls of sonographic IVC examination.

Over the past several decades, clinicians have incorporated several applications of diagnostic point-of-care ultrasound (POCUS) into medical ...

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The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire

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Varicocele relies heavily on angiographic diagnostic techniques for disease-related examination and assessment. In order to diagnose varicocele better, we combined supine and standing positions for varicocele imaging, and contrast-enhanced ultrasound is used for patients with inconspicuous reflux. This approach facilitates the early detection, diagnosis, and treatment of varicocele.

Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach

This protocol allows for the in vivo quantification of venous compliance and distensibility using catheterization and 3D angiography as a survival procedure allowing for a variety of potential applications.

Quantifying Inferior Vena Cava Compliance and Distensibility in an In Vivo Ovine Model Using 3D Angiography

The protocol here provides a rapid, phenotype-based approach for focused ultrasound evaluation of the hypotensive patient, using subcostal images of the inferior vena cava and heart, with additional views of the upper lungs and pleural spaces.

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

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.

Demystifying Venous Excess Ultrasound (VExUS): Image Acquisition and Interpretation

Here, we present a protocol for bedside POCUS application in ARDS management within the ICU. It details standardized techniques for lung, cardiac, diaphragm, venous, and gastric assessments to guide ventilation, predict weaning, and prevent complications.

The Application of Point-of-Care Ultrasonography (POCUS) in the Management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit

Learn a systematic ultrasound approach for inferior vena cava assessment to evaluate volume status in shock patients. This protocol minimizes common pitfalls and prioritizes technically achievable views for accurate clinical interpretation.

Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava

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