The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value

Citilcioglu, Serenat; Sebe, Ahmet; Ay, Mehmet Oğuzhan; İçme, Ferhat; Avcı, Akkan; Gülen, Müge; Şahan, Mustafa; Satar, Salim

doi:10.12669/pjms.302.4375

Cited by 22 publications

(17 citation statements)

References 17 publications

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“…There are few studies on the size of the IVC and its relationship to respiratory movements [1,2,10] or with central venous pressure [7,11,20] , and no studies correlating these data with the intravenous abdominal pressure. Using realhave concluded that three-dimensional CT is the most accurate method to study filter position and to assess safety Phlebography during the Valsalva maneuver that shows distribution of the contrast medium to renal and iliac veins; C: Computational study of inferior vena cava migration forces using an experimental set up and finite element simulation during the Valsalva maneuver.…”

Section: Discussionmentioning

confidence: 99%

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Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Laborda

Sierre

Malvè

et al. 2014

WJR

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AIM:To study changes produced within the inferior vena cava (IVC) during respiratory movements and identify their possible clinical implications. METHODS:This study included 100 patients (46 women; 54 men) over 18 years of age who required an abdominal computed tomography (CT) and central venous access. IVC cross-sectional areas were measured on CT scans at three levels, suprarenal (SR), juxtarenal (JR) and infrarenal (IR), during neutral breathing and again during the Valsalva maneuver. All patients were instructed on how to perform a correct Valsalva maneuver. In order to reduce the total radiation dose in our patients, low-dose CT protocols were used in all patients. The venous blood pressure (systolic, diastolic and mean) was invasively measured at the same three levels with neutral breathing and the Valsalva maneuver during venous port implantation. From CT scans, threedimensional models of the IVC were constructed and a collapsibility index was calculated for each patient. These data were then correlated with venous pressures and cross-sectional areas. RESULTS:The mean patient age was 51.64 ± 12.01 years. The areas of the ellipse in neutral breathing were 394.49 ± 85.83 (SR), 380.10 ± 74.55 (JR), and 342.72 ± 49.77 mm 2 (IR), and 87.46 ± 18.35 (SR), 92.64 ± 15.36 (JR) and 70.05 ± 9.64 mm 2 (IR) during the Valsalva (P s < 0.001). There was a correlation between areas in neutral breathing and in the Valsalva maneuver (P < 0.05 in all areas). Large areas decreased more than smaller areas. The collapsibility indices were 0.49 ± 0.06 (SR), 0.50 ± 0.04 (JR) and 0.50 ± 0.04 (IR), with no significant differences in any region. Reconstructed three-dimensional models showed a flattening of the IVC during Valsalva, adopting an ellipsoid cross-sectional shape. The mean pressures with neutral breathing were 9.44 ± 1.78 (SR), 9.40 ± 1.44 (JR) and 8.84 ± 1.03 mmHg (IR), and 81.08 ± 21.82 (SR), 79.88 ± 19.01 (JR) and 74.04 ± 16.56 mmHg (IR) during Valsalva (P s < 0.001). There was a negative correlation between cross-sectional caval area and venous blood pressure, but this was not statistically significant in any of the cases. There was a significant correlation between diastolic and mean pressures measured during neutral breathing and in Valsalva. CONCLUSION:Respiratory movements have a major influence on IVC dynamics. The increase in intracaval pressure during Valsalva results in a significant de-

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Section: Discussionmentioning

confidence: 99%

“…There is little data in the literature relating biometrics and hemodynamics of the IVC [9][10][11] . Kaura et al [12] studied the biometrics of the IVC and concluded that venography alone is not an ideal method to assess true IVC diameters.…”

Section: Introductionmentioning

confidence: 99%

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Laborda

Sierre

Malvè

et al. 2014

WJR

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“…According to Lorenzo et al (2012), the size of the inferior vena cava (IVC) is closely related to the results of the CVP assessment. The study states that measuring IVC diameter through ultrasonography can be used as determination of CVP values in indicating fluid volume status (Citilcioglu, 2014;Wiwatworapan, Ratanajaratroj & Sookananchai, 2012). In the right side HoB 30o position, IVC has kinking because the close IVC to the right facilitates suppression by the kidneys, and anatomically the location of the heart in the left hemithorax, when tilted to the right, the left side of the heart pushes to the right which causes the diameter of the right atrial space decreased, so that the volume of blood / venous return has decreased so that the impact on the decrease in blood pressure is greater when compared with the left lateral position (Hazebroek & Bonjer, 2011).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Central Venous Pressure (Cvp) Score among Patients on Mechanical Ventilator with Head of Bed (Hob) Elevation 30O; Neutral, Right, and Left Side Positions

Setiyawan

Ibrahim²,

Mulyati³

2019

J Kep Padjadjaran

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Early mobilization is important for critical patients to improve cough reflexes, eliminate bronchial secretions, facilitate work of mucociliary drainage muscles, and to prevent associated pneumonia ventilators and pressure sores. However, at the same time the patient often experiences vital signs change due to fluctuating conditions. Central Venous Pressure (CVP) measurement is oftenly needed to monitor central circulatory system. Unfortunately, in the clinical setting, the patient's position must be changed first in a 30o neutral head of bed (HoB) position rather than left or right side HoB position. This study aims to examine the differences in of CVP score among patients on mechanical ventilation at HoB position elevation 30o in a neutral, right side, and left side position. This quantitative comparative study involved 24 subjects who were recruited consecutively. Data were analyzed using ANOVA. The results showed that the mean CVP value at neutral HoB position elevation was 13.5 ± 3.96, right sight HoB elevation was 12.8 ± 4.16, and left side HoB elevation was 14.4 ± 4.17. There was a significant difference (p <0.05) among those three positions. Post hoc analysis test found the HoB position 30o neutral vs left side possition was higher and signifficantly difference with HoB elevation 30o neutral vs right side positions (p<0.05). This study suggested nurses need to consider the change of CVP values while changing patiens' position of HoB elevation 30o neutral, right side, and left side positions. Athough there was statistically difference among three positions, in fact, the value difference was less than 1 cmH2O which clinically did not see any differences.

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“…IVCD has been shown in previous studies to reflect the intravascular volume in HD patients and to correlate well with invasive methods like measurement of CVP for estimation of fluid volume. 9 This study has been done to measure IVCD and calculate IVC-CI to categorize the fluid status of regular hemodialysis patients. In this study, IVCe and IVCi were measured and the collapsibility indices of IVC calculated which correlated well with the amount of ultrafiltration done during hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Use of Handheld Ultrasound to Estimate Fluid Status of Hemodialysis Patients

Shrestha

Ghimire²,

Ansari³

et al. 2018

Nep. Med. J.

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Introduction: Accurate assessment of fluid status in hemodialysis patients presents a significant challenge. Nephrologists have long relied on dry weight estimation based solely on clinical parameters to decide the ultrafiltration volume for patients with end-stage kidney disease on dialysis. However, this method is far from accurate and many patients recurrently suffer from signs and symptoms of fluid overload or circulatory collapse from overaggressive ultrafiltration. Invasive methods such as measurement of central venous pressure cannot be used routinely. We evaluated the usefulness of inferior vena cava (IVC) diameter measured by handheld ultrasound in the estimation of fluid status in patients before and after hemodialysis. Materials and Methods: Clinical assessment included patients’ symptoms, weight, blood pressure, heart rate, and presence of edema before and after dialysis session. Dry weight was assessed based on the above parameters. Each patient underwent measurement of inferior vena cava before and after hemodialysis. The anteroposterior IVC diameter (IVCD) was measured 1.5 cm below the diaphragm in the hepatic segment in supine position during normal inspiration and expiration.Results: Thirty hemodialysis patients (mean age 51.6±18.03 years) were evaluated in outpatient dialysis unit. Following hemodialysis mean IVCe (IVC diameter in expiration) decreased from 1.40±0.38 to 0.91±0.30 cm (p<0.001). Similarly, mean IVCi (IVC diameter in inspiration) decreased from 0.67±0.34 to 0.35±0.19 cm (p<0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis (p<0.0001). The IVC collapsibility index (IVC-CI, per cent of change in IVC diameter in expiration vs. inspiration) increased significantly from 0.53±0.18 to 0.68±0.18 after dialysis (p=0.002). IVC diameter and IVC-CI clearly reflected alterations in fluid status. Regarding the clinical parameters of fluid status, following hemodialysis, mean heart rate increased from 81.17±5.21 beats per minute to 86.50±7.99, (p=0.003), systolic blood pressure increased from 148.67±26.36 mmHg to 155.00±28.50, (p=0.05), and diastolic blood pressure increased from 78.62±12.74 mmHg to 84.83±14.55, (p<0.001).Conclusions: Our findings support the applicability of IVCD measurement and IVC-CI in the estimation of fluid status in end stage kidney disease patients on hemodialysis. The clinical parameters of fluid status including heart rate, systolic blood pressure, and diastolic blood pressure suggest that significant numbers of patients underwent excess ultrafiltration based on their traditional dry weight calculation. Thus, using IVC parameters before and during hemodialysis might give a better estimation of fluid status of the patient and guide the amount of ultrafiltration to be done.

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The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value

Cited by 22 publications

References 17 publications

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

Comparison of Central Venous Pressure (Cvp) Score among Patients on Mechanical Ventilator with Head of Bed (Hob) Elevation 30O; Neutral, Right, and Left Side Positions

Use of Handheld Ultrasound to Estimate Fluid Status of Hemodialysis Patients

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