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Time for another #POCUS pitfalls thread 🧵: the infamous IVC 🤩
I have MANY thoughts on the IVC 💭
When I first started teaching POCUS, I actually disliked the IVC because it was often poorly done or incorrectly interpreted ❌
I have now come to love the IVC, BUT you have to do it right!
#tweetorial
Time for another #POCUS pitfalls thread 🧵: the infamous IVC 🤩
I have MANY thoughts on the IVC 💭
When I first started teaching POCUS, I actually disliked the IVC because it was often poorly done or incorrectly interpreted ❌
I have now come to love the IVC, BUT you have to do it right!
#tweetorial
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Firstly: it sounds obvious, but make sure what you're seeing is actually the IVC! ❗
We've all been fooled by an aorta at least once 🙈
The two vessels can be quite close together; but the aorta will be more medial; it will appear to be straighter, more vertical, and will have thicker walls
Firstly: it sounds obvious, but make sure what you're seeing is actually the IVC! ❗
We've all been fooled by an aorta at least once 🙈
The two vessels can be quite close together; but the aorta will be more medial; it will appear to be straighter, more vertical, and will have thicker walls
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You will also see the bright hyperechoic spine just deep to the aorta 👀
To confirm that what you're seeing is truly IVC: always try to visualize BOTH the hepatic vein (running into IVC) and the right atrium, as well as the IVC x.com
You will also see the bright hyperechoic spine just deep to the aorta 👀
To confirm that what you're seeing is truly IVC: always try to visualize BOTH the hepatic vein (running into IVC) and the right atrium, as well as the IVC x.com
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Next: beware the pitfalls of a single view!
This is an axiom that holds true for all of POCUS - always look in more than one view 👍
With the IVC, the short-axis provides a plethora of useful information; including shape/sphericity, which is arguably the most useful parameter of all
Next: beware the pitfalls of a single view!
This is an axiom that holds true for all of POCUS - always look in more than one view 👍
With the IVC, the short-axis provides a plethora of useful information; including shape/sphericity, which is arguably the most useful parameter of all
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Thirdly: avoid assessing the IVC right at the diaphragm ❌
The diaphragm can either stent the IVC open or "pinch it" during respiration, which is not the same as true collapse.
Train your eye (ideally) a couple cm distal to the hepatic vein x.com
Thirdly: avoid assessing the IVC right at the diaphragm ❌
The diaphragm can either stent the IVC open or "pinch it" during respiration, which is not the same as true collapse.
Train your eye (ideally) a couple cm distal to the hepatic vein x.com
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We also want to be wary of overcalling "IVC collapse" in the long-axis, especially if we're losing the clearly defined borders of the vessel with inspiration 📏
You may be seeing lateral translation of the IVC with respiration - it's moving out of your plane of view - rather than true collapse
We also want to be wary of overcalling "IVC collapse" in the long-axis, especially if we're losing the clearly defined borders of the vessel with inspiration 📏
You may be seeing lateral translation of the IVC with respiration - it's moving out of your plane of view - rather than true collapse
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We always want to make sure we're seeing bright hyperechoic borders of of vessel, which is a good indication that we're still on-axis 📏
(This is another fantastic reason to do a short-axis view; as it helps avoid this pitfall!)
We always want to make sure we're seeing bright hyperechoic borders of of vessel, which is a good indication that we're still on-axis 📏
(This is another fantastic reason to do a short-axis view; as it helps avoid this pitfall!)
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Next: don't forget your troubleshooting arsenal 🏹
The IVC can be tough, so it's worth having a couple tricks up your sleeve for challenging cases 🃏
For example - the phased array probe (vs the curvilinear) often nestles better into the subxiphoid space, giving you a better view.
Next: don't forget your troubleshooting arsenal 🏹
The IVC can be tough, so it's worth having a couple tricks up your sleeve for challenging cases 🃏
For example - the phased array probe (vs the curvilinear) often nestles better into the subxiphoid space, giving you a better view.
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The transhepatic view - sometimes called the rescue view - is another great option for difficult cases ⛑️
This is found in the mid-axillary line in a coronal plane (for the long-axis). From your standard view of the kidney, fan or slide your probe anteriorly until the IVC pops into view.
The transhepatic view - sometimes called the rescue view - is another great option for difficult cases ⛑️
This is found in the mid-axillary line in a coronal plane (for the long-axis). From your standard view of the kidney, fan or slide your probe anteriorly until the IVC pops into view.
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And finally - and most importantly!! - you have to ask the IVC the right question ⁉️
You cannot expect too much of the IVC.
It is not a single answer to the ubiquitous "volume status" question 🤦♀️
It is ONE data point.
It correlates well with CVP.
And finally - and most importantly!! - you have to ask the IVC the right question ⁉️
You cannot expect too much of the IVC.
It is not a single answer to the ubiquitous "volume status" question 🤦♀️
It is ONE data point.
It correlates well with CVP.
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It is MUCH more useful for fluid tolerance vs fluid responsiveness ⚖️
I've given whole talks on this in the past; and (shameless plug) this will be discussed extensively at the #HR25 conference in May for those of you who want to come join us! 🌟
ccusinstitute.wixsite.com
It is MUCH more useful for fluid tolerance vs fluid responsiveness ⚖️
I've given whole talks on this in the past; and (shameless plug) this will be discussed extensively at the #HR25 conference in May for those of you who want to come join us! 🌟
ccusinstitute.wixsite.com
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Thanks for reading! 📖 🙏
Hopefully this was useful and will help you level up your IVC scanning.
Drop your IVC scanning tips below!
#MedTwitter #POCUSTwitter #tweetorial #echofirst
Thanks for reading! 📖 🙏
Hopefully this was useful and will help you level up your IVC scanning.
Drop your IVC scanning tips below!
#MedTwitter #POCUSTwitter #tweetorial #echofirst
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