Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ Technique ++ The transducer indicator is directed toward the patient’s feet. The transducer is placed subxiphoid in a midline plane and tilted toward the patient’s right to identify the IVC as it enters the right atrium (Fig. 24.46). Identify the liver, IVC, right atrium, and right hepatic vein (Fig. 24.47). Measure the IVC 2 to 3 cm caudal to the entry point to the right atrium. Measure the IVC through the respiratory cycle at end inspiration and expiration (Fig. 24.48). ++ FIGURE 24.46 IVC View. The transducer is placed subxiphoid in a midline plane and tilted toward the patient’s right to identify the IVC as it enters the right atrium. (Photo contributor: Lawrence B. Stack, MD.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) ++ FIGURE 24.47 IVC View. The liver is seen with the IVC entering the right atrium on the left. Probe marker (on right of the screen) is directed inferiorly here. (Ultrasound contributor: Jeremy S. Boyd, MD.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) ++ FIGURE 24.48 IVC View. Measure the IVC 2 to 3 cm distal to the entry point to the RA; 1.5 to 2.5 cm is considered a normal IVC diameter. Greater than 2.5 cm is considered an enlarged or “plethoric” IVC. (Ultrasound contributor: Jeremy S. Boyd, MD.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) +++ Abnormal Findings ++ IVC collapse: The IVC should partially collapse during the normal respiratory cycle in nonventilated patients. A totally collapsed IVC is indicative of low central venous pressure (CVP). More than 50% collapse is less specific but also indicative of low CVP (Fig. 24.49). IVC size: The size of the IVC may be measured throughout the respiratory cycle. In general, an IVC that measures 2 cm or greater with poor respiratory variation is indicative of elevated CVPs due to volume overload, RV failure, and/or tamponade physiology (Fig. 24.50A,B). IVC distensibility: In patients receiving positive-pressure ventilation, the IVC will distend rather than collapse during inspiration. Measurements of IVC distensibility in ventilated patients can be used to calculate volume responsiveness to intravenous fluid challenge. ++ FIGURE 24.49 IVC View. A totally collapsed IVC is indicative of low CVP. (Ultrasound contributor: Jeremy S. Boyd, MD.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) ++ FIGURE 24.50A, B IVC View. An IVC with poor respiratory variation (demonstrated in M-mode) is indicative of elevated central venous pressures due to volume overload, right ventricular failure, and/or tamponade physiology. (Ultrasound contributor: Jim Fiechtl, MD.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) ++ Vedio Graphic Jump Location Video 24-20: IVC View Play Video ++ Vedio Graphic Jump Location Video 24-21: IVC ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options