3. Echocardiography Protocol

Step 5 : Inferior vena cava

Evaluating the Inferior Vena Cava (IVC) with ultrasound is one of the most commonly used Point of Care Ultrasound (POCUS) applications. It is a great way to estimate central venous pressure (CVP) and fluid tolerance.

  • From the Subxiphoid view with the patient still in the supinated position with knees bent, keep the right atrium in view.
  • Locate the Inferior Vena Cava within the Liver and center it on the ultrasound screen.
  • Once the IVC is centered on the screen, rotate the transducer clockwise (to your right) to bring the indicator down toward the feet (play the instructional video).
  • This will give a longitudinal view of the Inferior Vena Cava entering the Right Atrium.
IVC Ultrasound Probe Position
IVC Inferior Vena Cava Cardiac Ultrasound Echocardiography Short to Long Axis
IVC View – Going from Short Axis to the Long Axis View

Structures to identify in the Inferior Vena Cava (IVC) View:

  • IVC: Inferior Vena Cava
  • RA: Right atrium
  • HV: Hepatic Vein (sometimes seen)
IVC View

Assessing for IVC Collapsibility:

  • After you obtain the IVC view you will need to assess for IVC collapsibility in either your spontaneously breathing or ventilated patients.
  • For Spontaneously Breathing Patients: have them take a deep breath or have them sniff in. The maximum IVC diameter will be seen during expiration and the minimum IVC diameter will be seen during inspiration for these patients.
  • For Ventilated Patients: The positive pressure from the ventilator will have the opposite effect on the IVC compared to spontaneously breathing patients. The maximum IVC diameter will be seen during inspiration and the minimum IVC diameter will be seen during expiration for these patients.

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