Nurse-delivered focused echocardiography to determine intravascular volume status in a deployed maritime critical care unit

2015 ◽  
Vol 101 (2) ◽  
pp. 124-128 ◽  
Author(s):  
S Hutchings ◽  
L Bisset ◽  
L Cantillon ◽  
P Keating-Brown ◽  
S Jeffreys ◽  
...  
Keyword(s):  
Critical Care ◽  
Vena Cava ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Volume Status ◽  
Intravascular Volume ◽  
Mean Values ◽  
The Uk ◽  
Focused Echocardiography ◽  
Intravascular Volume Status

AbstractFocused echocardiography is increasingly used by clinicians to guide fluid resuscitation. The UK Defence Medical Services (DMS) have adopted focused echocardiography as a tool to guide flow assessment and resuscitation in deployed critical care. We aimed to explore whether two focused echo techniques, namely Inferior Vena Cava (IVC) and Left Ventricular Outflow Tract Velocity Time integer (LVOT VTi) respiratory variability could be taught to a group of critical care nurses without previous exposure to ultrasound imaging. After a five-week program of training, validation was carried out on healthy volunteers. The mentor, an accredited focused echo trainer, and six nurses performed a total of forty-eight scans on eleven volunteers. The mentor and students acquired subcostal long axis views of the IVC and apical five chamber views using a high frequency linear ultrasound probe. Mean values from three measurements were obtained for IVC diameter and LVOT VTi. Minimum and maximum values were recorded for both variables across a full respiratory cycle. Echo images were saved and at least two images for each student were reviewed offline by an accredited echo-training supervisor. In all cases students were able to obtain adequate echo windows. There was good correlation between values recorded by the mentor and students for both IVC diameter (r=0.90, p<0.001) and LVOT VTi (r=0.77, p<0.001). Bland Altman analysis showed good correlation with minimal bias for VTi measurements. There was some increase in bias for IVC measurements below 1.2 cm. In summary, we found that these skills for assessing intravascular volume status could be acquired in a relatively short time by specialist nurses without previous experience, and that results were comparable to those produced by an experienced practitioner.

Does the intravascular volume status in haemodialysis patients measured by inferior vena cava ultrasound correlate with bioimpedance spectroscopy?

2019 ◽  
Vol 28 (11-12) ◽  
pp. 2135-2146 ◽  
Author(s):  
Ulrich Steinwandel ◽  
Nick Gibson ◽  
Amanda Towell‐Barnard ◽  
Richard Parsons ◽  
James Rippey ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Volume Status ◽  
Bioimpedance Spectroscopy ◽  
Intravascular Volume ◽  
Intravascular Volume Status

scholarly journals Non-invasive Assessment of Intravascular Volume Status for Postoperative Patients: The Correlation Between the Internal Jugular Vein/Common Carotid Artery Cross-Sectional Area Ratio and the Inferior Vena Cava Diameter

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Samaa A Kasem ◽  
Ahmed Goda Ahmed ◽  
Hebattallah Nagm Eldeen ◽  
Dina Y Kassim
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Volume Status ◽  
Intravascular Volume ◽  
Cross Sectional ◽  
Minimum Diameter ◽  
Fluid Infusion ◽  
Non Invasive ◽  
Before And After ◽  
Intravascular Volume Status

Background: This study aimed to assess the correlation between the internal jugular vein/common carotid artery (IJV/CCA) cross-sectional area (CSA) ratio and the inferior vena cava (IVC) diameter as non-invasive techniques for the assessment of intravascular volume. Methods: The study samples included 35 adult patients of both sexes (age range: 20 - 60 years) according to the criteria of the American Society of Anaesthesiology (ASA) physical status II - III, who were admitted to the surgical intensive care unit (SICU) after major surgeries for the assessment of intravascular volume status. Results: There was a positive correlation between the IJV/CCA CSA ratio and the IVC maximum and minimum diameter before and after fluid infusion (r = 0.923, P < 0.001 and r = 0.390, P = 0.021, respectively) and between the IJV/CCA CSA ratio at inspiration and the IVC minimum diameter before and after fluid infusion (r = 0.605, P < 0.001 and r = 0.496, P < 0.001, respectively). The sensitivity and specificity analysis of the IJV/CCA CSA during inspiration after fluid correction to predict a central venous pressure (CVP) of 8 - 12 cmH2O showed that at a ratio of 2.56, the highest sensitivity was 56.5%, and the specificity was 83.3%; at a ratio of 2.58, the highest sensitivity was 65.2% and the specificity was 75%. During expiration, specificity after fluid correction was 56.62%; at a ratio of 2.62, the highest sensitivity was 52.2%, and the specificity was 67%; and at a ratio of 2.65, the sensitivity was 56.5%, and the specificity was 50%. Conclusions: The assessment of the IJV/CCA CSA ratio alongside ultrasonography could be a non-invasive tool for the evaluation of intravascular volume status in spontaneously breathing adult patients after major surgeries.

A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS CORRELATION OF CAVAL AORTA INDEX WITH CENTRAL VENOUS PRESSURE FOR INTRAVASCULAR VOLUME ASSESSMENT IN PATIENTS UNDERGOING ENDOSCOPIC TRANSURETHERAL RESECTION OF PROSTATE (TURP)

2021 ◽  
pp. 10-12
Author(s):  
N. Senthil kumar ◽  
Jeya Pratheef Muthiah
Keyword(s):  
Prospective Observational Study ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Volume Status ◽  
Intravascular Volume ◽  
Central Venous ◽  
Sonographic Evaluation ◽  
Volume Assessment ◽  
The Mean

INTRODUCTION: There are various techniques for assessing the uid status such as clinical examination, central venous pressure (CVP) measurement, biochemical markers, bio impedance, continuous blood volume measurement, or sonographic inferior vena cava (IVC) diameter assessment. Sonographic evaluation of the IVC and Aorta diameter and its usefulness in evaluating the volume status are studied and documented. The sonographic evaluation of the IVC & Aorta can predict the volume status, this tool can assist anesthetist in rapid diagnosis and prompt resuscitation of patients developing TURP syndrome AIM OF THE STUDY: The aim & objective of this study is to assess the correlation of Caval Aorta index with CVP in intravascular volume assessment in patients undergoing endoscopic Trans Urethral Resection of Prostate (TURP) MATERIALS AND METHODS: The study is carried out in the Department of Anaesthesiology involving Department of Urology in Kanyakumari Government Medical College from January 2018 to June 2019. It is a Prospective observational study. To measure the IVC diameter USG machine probe is placed in the sub-xiphoid region to visualize the conuence of the hepatic veins draining the IVC. The maximum internal AP diameter of the Aorta(Ao) and maximum internal anterior-posterior (AP) diameter of the IVC is measured in the longitudinal plane. Fluid status will be measured by CVP and IVC/Ao index recorded before neuraxial block, after preload, at 5 min after intrathecal block, resection time at 0 min, every 15 min during the rst 30 min, then every 30 min, until the end of surgery. Outcome: Incidence of hypotension after spinal anesthesia in a cesarean section RESULTS: The mean IVC diameter at pre-operative is 15.20±1.42, and at 60 min, 75 min were 19.39±1.92, 20.03±1.76 which suggests that the size and shape of the inferior vena cava (IVC) is correlated to the CVP and circulating blood volume. In my study the mean Aortic diameter at 60 min, 75 min were 20.30±1.01 and 19.81±1.06 which is same as the preoperative level (19.72±1.18) and diameter. The mean CVP at pre-operative is 4.57±0.73, mean CVP at 60 min, 75 min were 7.57±0.82, 8.11±0.78 which denotes that CVP increases as the intravascular volume status increases. In our study mean IVC/Aortic index at pre-operative is 0.77±0.05 and the mean IVC/Aortic index at 15min, 30 min, 60 min, 75 min were 0.87±0.03, 0.90±0.04, 0.95±0.06, 1.01±0.05 which increases signicantly in increasing intravascular volume. The strong correlation between these two variable with Pearson formula ranging from 0.450-0.900. CONCLUSION: As Sonographic caval Ao index is very well correlated with CVP , IVC/Ao index is useful for the evaluation of preoperative and intraoperative volume status, especially in major surgeries with marked uid shift or blood loss and had the advantage of being noninvasive, safe, quick, and easy technique with no complications.

Comprehensive transthoracic cardiac imaging in mice using ultrasound biomicroscopy with anatomical confirmation by magnetic resonance imaging

2004 ◽  
Vol 18 (2) ◽  
pp. 232-244 ◽  
Author(s):  
Yu-Qing Zhou ◽  
F. Stuart Foster ◽  
Brian J. Nieman ◽  
Lorinda Davidson ◽  
X. Josette Chen ◽  
...  
Keyword(s):  
Cardiac Imaging ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
High Frequency Ultrasound ◽  
The Right

High-frequency ultrasound biomicroscopy (UBM) has recently emerged as a high-resolution means of phenotyping genetically altered mice and has great potential to evaluate the cardiac morphology and hemodynamics of mouse mutants. However, there is no standard procedure of in vivo transthoracic cardiac imaging using UBM to comprehensively phenotype the adult mice. In this paper, the characteristic mouse thoracic anatomy is elucidated using magnetic resonance (MR) imaging on fixed mice. Besides the left parasternal and apical windows commonly used for transthoracic ultrasound cardiac imaging, a very useful right parasternal window is found. We present strategies for optimal visualization using UBM of key cardiac structures including: 1) the right atrial inflow channels such as the right superior vena cava; 2) the right ventricular inflow tract via the tricuspid orifice; 3) the right ventricular outflow tract to the main pulmonary artery; 4) the left atrial inflow channel, e.g., pulmonary vein; 5) the left ventricular inflow tract via the mitral orifice; 6) the left ventricular outflow tract to the ascending aorta; 7) the left coronary artery; and 8) the aortic arch and associated branches. Two-dimensional ultrasound images of these cardiac regions are correlated to similar sections in the three-dimensional MR data set to verify anatomical details of the in vivo UBM imaging. Dimensions of the left ventricle and ascending aorta are measured by M-mode. Flow velocities are recorded using Doppler at six representative intracardiac locations: right superior vena cava, tricuspid orifice, main pulmonary artery, pulmonary vein, mitral orifice, and ascending aorta. The methodologies and baseline measurements of inbred mice provide a useful guide for investigators applying the high-frequency ultrasound imaging to mouse cardiac phenotyping.

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