Related Experiment Video
Updated: Mar 26, 2026
Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Agreement between inferior vena cava diameter measurements by subxiphoid versus transhepatic views
Atul Prabhakar Kulkarni1, S Janarthanan1, M M Harish1
1Division of Critical Care Medicine, Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Context:
Correcting hypovolemia is extremely important. Central venous pressure measurement is often done to assess volume status. Measurement of inferior vena cava (IVC) is conventionally done in the subcostal view using ultrasonography. It may not be possible to obtain this view in all patients.
Aims:
We therefore evaluated the limits of agreement between the IVC diameter measurement and variation in subcostal and that by the lateral transhepatic view.
Settings And Design:
Prospective study in a tertiary care referral hospital intensive care unit.
Subjects And Methods:
After Institutional Ethics Committee approval and informed consent, we obtained 175 paired measurements of the IVC diameter and variation in both the views in adult mechanically ventilated patients. The measurements were carried out by experienced researchers. We then obtained the limits of agreement for minimum, maximum diameter, percentage variation of IVC in relation to respiration.
Statistical Analysis Used:
Bland-Altman's limits of agreement to get precision and bias.
Results:
The limits of agreement were wide for minimum and maximum IVC diameter with variation of as much as 4 mm in both directions. However, the limits of agreement were much narrower when the percentage variation in relation to respiration was plotted on the Bland-Altman plot.
Conclusions:
We conclude that when it is not possible to obtain the subcostal view, it is possible to use the lateral transhepatic view. However, using the percentage variation in IVC size is likely to be more reliable than the absolute diameter alone. It is possible to use both views interchangeably.
