The study aims to standardize patient positioning during bedside ultrasound assessment of internal jugular vein (IJV) and correlate the results with invasive hemodynamics obtained immediately after. The study hypothesizes that the respiratory variation in the size of IJV, as estimated through ultrasound at bedside, is an accurate estimation of the patient's actual right atrial pressure estimated through right heart catheterization.
Study Type
OBSERVATIONAL
Enrollment
182
Patients scheduled to undergo right heart catheterization (RHC) as their standard of care will be included in the study. The patient will be positioned supine at 0 degrees with normal restful breathing and patient looking straight up. After the right sternocleidomastoid muscle is identified, internal jugular vein (IJV) will be imaged at the apex of the triangle formed by the sternal and clavicular heads of the muscle. Similarly, the inferior vena cava (IVC) will be imaged at the caudal end of the sternum. The diameters of both the veins will be noted during normal respiration. The patients will then be asked to sniff and collapsibility of the veins will be noted. No pressure will be applied on the neck. The anticipated duration for image acquisition is between 5 to 10 minutes. The patients will undergo the scheduled RHC within 1 hour as scheduled.
University of Kentucky
Lexington, Kentucky, United States
Cross-sectional diameters of the internal jugular vein (IJV)
The respiratory variation percentage will assessed using M-mode of the ultrasound while the patient is breathing normally. The maximum and minimum anteroposterior diameter will be noted using M-mode (in mm).
Time frame: 5 minutes
Cross-sectional diameters of the internal jugular vein (IJV)
Diameter variation index will be calculated as: (maximum diameter - minimum diameter)/ body surface area.
Time frame: 5 minutes
Sniff collapsibility of IJV
Complete collapse (0cm) of the anteroposterior diameter of IJV on sniff maneuver by the patient, as assessed by M-mode on the ultrasound.
Time frame: 10 minutes
Cross-sectional diameters of the inferior vena cava (IVC)
Maximum diameter - noted using M-mode (in mm) of the ultrasound machine.
Time frame: 5 minutes
Cross-sectional diameters of the inferior vena cava (IVC)
Respiratory variation - assessed using M-mode of the ultrasound while the patient is breathing normally. This will be calculated as (maximum diameter - minimum diameter)/maximum diameter and expressed as a percentage. The maximum and minimum diameters will be noted using M-mode (in mm).
Time frame: 5 minutes
Cross-sectional diameters of the inferior vena cava (IVC)
Sniff collapsibility - Complete collapse (0cm) of the cross sectional diameter of IVC on sniff maneuver by the patient, as assessed by M-mode of the ultrasound.
Time frame: 5 minutes
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