Bedside Ultrasound for Fluid Estimation

Correlation of Internal Jugular and Inferior Vena Cava Diameter Variation on Bedside Ultrasound With Invasive Right Heart Catheterization

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 Overview

• Status: Completed
• Conditions: Catheterization
• Intervention / Treatment: Device: Ultrasound imaging

• Study Type: Observational
• Enrollment (Actual): 182

Contacts and Locations

Study Locations

• United States
  • Kentucky
    • Lexington, Kentucky, United States, 40506
      • University of Kentucky

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Consecutive adult patients scheduled to undergo right heart catheterization.

Description

Inclusion Criteria:

• Undergoing right heart catheterization

Exclusion Criteria:

• Superior vena cava obstruction or compression
• Severe tricuspid regurgitation
• Mechanically ventilated patients

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Right heart catheterization

Device: Ultrasound imaging; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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).	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.	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.	10 minutes
Cross-sectional diameters of the inferior vena cava (IVC)	Maximum diameter - noted using M-mode (in mm) of the ultrasound machine.	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).	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.	5 minutes

Collaborators and Investigators

• Sponsor: Gaurang Vaidya
• Investigators: Principal Investigator: Gaurang Vaidya, MD, University of Kentucky

Publications and helpful links

General Publications

• Vaidya GN, Kolodziej A, Stoner B, Galaviz JV, Cao X, Heier K, Thompson M, Birks E, Campbell K. Bedside ultrasound of the internal jugular vein to assess fluid status and right ventricular function: The POCUS-JVD study. Am J Emerg Med. 2023 Jun 6;70:151-156. doi: 10.1016/j.ajem.2023.05.042. Online ahead of print.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2021
• Primary Completion (Actual): March 30, 2022
• Study Completion (Actual): April 30, 2022

Study Registration Dates

• First Submitted: November 17, 2021
• First Submitted That Met QC Criteria: December 1, 2021
• First Posted (Actual): December 15, 2021

Study Record Updates

• Last Update Posted (Actual): July 14, 2023
• Last Update Submitted That Met QC Criteria: July 12, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: Right heart catheterization; Internal jugular vein; Inferior vena cava
• Other Study ID Numbers: 67340

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No