2. When to use POCUS for Venous Congestion

When to use POCUS for Venous Congestion

Evaluation for venous congestion using Point of Care Ultrasound (VExUS POCUS) can be performed when trying to assess the fluid status of the patient. This can be especially important in our septic shock, congestive heart failure, and acute renal failure patients to help give us more data points towards starting fluids, stoping fluids, diureses, or vasopressor choice.

This exam should be done in conjunction with the clinical picture, lab values, and hemodynamic status of the patient. It should also be combined and interpreted along with cardiac ultrasound findings when possible.

The VExUS Score can give you evidence of venous congestion in the liver, gut, and kidneys to help predict early signs of end-organ damage and allow you to change/optimize your fluid management approach for your patient. It can also prompt you to look for the etiologies of your venous congestion such as causes of right heart failure.

Organs to Evaluate Using the VExUS Ultrasound Score Protocol

Below are the organs you will be evaluating using the VExUS Ultrasound Protocol (aka Protocolo Vexus). As you can see, you can get a glimpse of venous congestion from several points prior to blood entering the right heart.

  1. Inferior Vena Cava
  2. Liver (hepatic veins)
  3. Gut (portal veins)
  4. Kidneys (intrarenal veins)