Point-of-Care Ultrasound of Inferior Vena Cava

How to perform a point-of-care ultrasound of the inferior vena cava to assess patient volume status and collapsibility.

A previous version of this video included incorrect values. None of these errors alter the conclusions. This video and the related article have been corrected. Point-of-care ultrasound can be used to assess the inferior vena cava (IVC) for diameter and collapsibility by calculating the IVC collapsibility index as an assessment of patient volume status. When a patient has volume overload, the IVC will be enlarged and will collapse less with inspiration than in a person who is euvolemic. To measure the IVC collapsibility index, position the patient supine. Using the curvilinear or phased-array probe with the machine set to the abdominal preset, place the probe in the subxiphoid region, just to the right of the patient’s midline with the probe’s orientation marker pointing cephalad. Using the liver as an acoustic window, visualize the IVC as a longitudinal, anechoic (black) structure draining into the right atrium. Capture images of the IVC at its maximum (during exhalation) and its minimum (during forced expiration) and take measurements of the diameter to calculate the IVC collapsibility index. The IVC collapsibility index is the ratio of the difference between the maximum (expiratory) and the minimum (inspiratory) IVC diameters, divided by the maximum diameter, expressed as a percentage. At a threshold of less than 50%, the IVC collapsibility index has a specificity of 79% for volume overload whereas a normal IVC index of greater than 50% has a sensitivity of 82% for decreased likelihood of volume overload. Click ja.ma/4w8KR1R for the related article. For more, check out: Point-of-Care Ultrasonography of Pulmonary B-Lines youtu.be/MFUgiQxMZnc Point-of-Care Ultrasonography of Jugular Venous Pressure youtu.be/MqR9PXItsAU