DETERMINATION OF INTRAVASCULAR VOLUME STATUS BY MEASURING IVC DIAMETER ON ULTRASONOGRAPHY IN HEMODIALYSIS PATIENTS KEEPING CVP AS GOLD STANDARD

Dr Shehla Iftikhar; Muhammad Omer Aamir; Dr Imran Masud Qasmi; Dr Hina Manzoor; dr Saniya mushtaque; Dr fahad saleem; Dr Mehwish Razzaq

DETERMINATION OF INTRAVASCULAR VOLUME STATUS BY MEASURING IVC DIAMETER ON ULTRASONOGRAPHY IN HEMODIALYSIS PATIENTS KEEPING CVP AS GOLD STANDARD

Dr Shehla Iftikhar, Muhammad Omer Aamir, Dr Imran Masud Qasmi, Dr Hina Manzoor, dr Saniya mushtaque, Dr fahad saleem, Dr Mehwish Razzaq

Abstract

Background: Among the indices able to replace invasive central venous pressure (CVP) measurement in patients undergoing hemodialysis the diameters of the inferior vena cava (IVC) and their respiratory fluctuations, so-called IVC collapsibility index (IVCCI), measured by echocardiography, have recently gained ground as a quite reliable proxy of CVP.

Objective: The aim of our study was to determine the accuracy of intravascular volume status by measuring inferior vena cava (IVC) diameter on ultrasound, keeping central venous pressure (CVP) as a gold standard in patients undergoing hemodialysis.

Material and Method: This prospective cross sectional descriptive study was carried out over a period of six months from 16-09-2015 to 15-03-2016 at radiology department Combined Military Hospital Quetta. A total of 174 patients (107 males (61.5%) and 67 females (38.5%). were included in this study. patient’s age, sex, CVP and IVC diameter measurement values at inspiration and expiration, arterial blood pressure, heart rate was recorded. serial longitudinal and transverse images were taken in sub-xiphoid region and maximum anteroposterior (AP) diameter of inferior vena cava from outer to inner was taken just caudal to the confluence of hepatic veins in its longitudinal plane by b.

Results: In this study on ultrasound IVC diameter within normal limit was seen in 51 cases and not within normal limits was seen in 123 cases. CPV not within normal limits was found in 118 cases and within normal limit was observed in 56 cases. sensitivity, specificity, diagnostic accuracy of IVC (ultrasound) was 91.2%, 73.2% and 85.6%, respectively. positive predictive value was 87.8% and negative predictive value was 80.3%.Conclusion: Ultrasound assessment of IVC dimensions can be performed easily. Use of ultrasound to determine intravascular volume status may help to reduce intradialytic post dialytic adverse events and prevent long-term cardiovascular complications.Key words: IVC, CVPS, intravascular volume status, ultrasonography

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