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Technique

  • The transducer indicator is directed toward the patient’s feet.

  • The transducer is placed subxiphoid in a midline plane and tilted toward the patient’s right to identify the IVC as it enters the right atrium (Fig. 24.46).

  • Identify the liver, IVC, right atrium, and right hepatic vein (Fig. 24.47).

  • Measure the IVC 2 to 3 cm caudal to the entry point to the right atrium. Measure the IVC through the respiratory cycle at end inspiration and expiration (Fig. 24.48).

FIGURE 24.46

IVC View. The transducer is placed subxiphoid in a midline plane and tilted toward the patient’s right to identify the IVC as it enters the right atrium. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 24.47

IVC View. The liver is seen with the IVC entering the right atrium on the left. Probe marker (on right of the screen) is directed inferiorly here. (Ultrasound contributor: Jeremy S. Boyd, MD.)

FIGURE 24.48

IVC View. Measure the IVC 2 to 3 cm distal to the entry point to the RA; 1.5 to 2.5 cm is considered a normal IVC diameter. Greater than 2.5 cm is considered an enlarged or “plethoric” IVC. (Ultrasound contributor: Jeremy S. Boyd, MD.)

Abnormal Findings

  • IVC collapse: The IVC should partially collapse during the normal respiratory cycle in nonventilated patients. A totally collapsed IVC is indicative of low central venous pressure (CVP). More than 50% collapse is less specific but also indicative of low CVP (Fig. 24.49).

  • IVC size: The size of the IVC may be measured throughout the respiratory cycle. In general, an IVC that measures 2 cm or greater with poor respiratory variation is indicative of elevated CVPs due to volume overload, RV failure, and/or tamponade physiology (Fig. 24.50A,B).

  • IVC distensibility: In patients receiving positive-pressure ventilation, the IVC will distend rather than collapse during inspiration. Measurements of IVC distensibility in ventilated patients can be used to calculate volume responsiveness to intravenous fluid challenge.

FIGURE 24.49

IVC View. A totally collapsed IVC is indicative of low CVP. (Ultrasound contributor: Jeremy S. Boyd, MD.)

FIGURE 24.50A, B

IVC View. An IVC with poor respiratory variation (demonstrated in M-mode) is indicative of elevated central venous pressures due to volume overload, right ventricular failure, and/or tamponade physiology. (Ultrasound contributor: Jim Fiechtl, MD.)

Vedio Graphic Jump Location
Video 24-21: IVC View: Plethoric ...

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