Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department
Dublin Core
Title
Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department
Subject
POCUS (point of Care Ultrasound), Femoral vein Collapsibility Index, Volume assessment, Inferior Vena
Cava, Volume responsiveness, Emergency Department.
Cava, Volume responsiveness, Emergency Department.
Description
Abstract
Background Inferior vena cava (IVC) diameter measurement using ultrasound for volume status assessment has
shown satisfactory results and is being adopted in Emergency and critical care settings. IVC diameter can vary
depending on the cardiac function, respiratory efforts, intraabdominal pressure, and mechanical ventilation. Due
to these factors, IVC measurement cannot be considered a stand-alone technique appropriate for every patient.
The femoral vein (FV), a more superficial vein than IVC, can be considered an alternative method for assessing fluid
responsiveness in patients presenting to the Emergency department. It is easily accessible and can be used in
scenarios where IVC cannot be visualized or reliable.
Methods This was a single-center diagnostic study where 85 patients who presented to the ED with chest pain were
enrolled prospectively. IVC and femoral vein collapsibility indices, stroke volume, and cardiac output are measured
using an ultrasound machine. The measurements were repeated after a passive leg-raising test. These values were
compared with each other to assess an intra-class correlation between IVC and femoral vein collapsibility indices. We
have also evaluated the relationship between the collapsibility indices of both veins and cardiac output.
Discussion & limitations Our findings show an insufficient correlation between IVC and FV collapsibility indices.
However, both vein diameters significantly increased after passive leg raising (PLR), indicating a response to fluid
challenge. Post-PLR reduced IVC, and FV collapsibility index (CI) suggests intravascular volume expansion after a fluid
challenge, also reflected in the hemodynamic parameters. Our study was conducted only in a subset of relatively
stable patients. The applicability of the study in different subsets of patients presenting to ED is still questionable.
Conclusion We conclude that femoral vein indices may not be an accurate alternative for volume assessment in the
chosen cohort of patients. IVC and FV metrics do not correlate and may not be accurate for volume responsiveness.
We may need to explore the utility of FV and its indices in a larger population in multiple settings for a better
understanding of its role in volume assessment and responsiveness.
Trial registration (EC/NEW/INST/2021/1707). Registered 03 January 2023.
Background Inferior vena cava (IVC) diameter measurement using ultrasound for volume status assessment has
shown satisfactory results and is being adopted in Emergency and critical care settings. IVC diameter can vary
depending on the cardiac function, respiratory efforts, intraabdominal pressure, and mechanical ventilation. Due
to these factors, IVC measurement cannot be considered a stand-alone technique appropriate for every patient.
The femoral vein (FV), a more superficial vein than IVC, can be considered an alternative method for assessing fluid
responsiveness in patients presenting to the Emergency department. It is easily accessible and can be used in
scenarios where IVC cannot be visualized or reliable.
Methods This was a single-center diagnostic study where 85 patients who presented to the ED with chest pain were
enrolled prospectively. IVC and femoral vein collapsibility indices, stroke volume, and cardiac output are measured
using an ultrasound machine. The measurements were repeated after a passive leg-raising test. These values were
compared with each other to assess an intra-class correlation between IVC and femoral vein collapsibility indices. We
have also evaluated the relationship between the collapsibility indices of both veins and cardiac output.
Discussion & limitations Our findings show an insufficient correlation between IVC and FV collapsibility indices.
However, both vein diameters significantly increased after passive leg raising (PLR), indicating a response to fluid
challenge. Post-PLR reduced IVC, and FV collapsibility index (CI) suggests intravascular volume expansion after a fluid
challenge, also reflected in the hemodynamic parameters. Our study was conducted only in a subset of relatively
stable patients. The applicability of the study in different subsets of patients presenting to ED is still questionable.
Conclusion We conclude that femoral vein indices may not be an accurate alternative for volume assessment in the
chosen cohort of patients. IVC and FV metrics do not correlate and may not be accurate for volume responsiveness.
We may need to explore the utility of FV and its indices in a larger population in multiple settings for a better
understanding of its role in volume assessment and responsiveness.
Trial registration (EC/NEW/INST/2021/1707). Registered 03 January 2023.
Creator
Neeraja A Nair1 , Freston Marc Sirur1 and Vimal Krishnan S1*
Source
https://doi.org/10.1186/s12245-024-00762-7
Date
2024
Contributor
Peri Irawan
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Neeraja A Nair1 , Freston Marc Sirur1 and Vimal Krishnan S1*, “Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12530.