Kotevska Angjushev Marija, Angjushev Darko, Djordjevic Dikic Ana
Cardiovascular Department, University Clinic of Cardiac Surgery, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
Intensive Care Unit, Anesthesiology Department, University Clinic for Traumatology, Orthopaedic Diseases, Anaesthesia, Reanimation, Intensive Care and Emergency Centre, Skopje, North Macedonia.
Ultrasound. 2025 Sep 11:1742271X251353722. doi: 10.1177/1742271X251353722.
Bedside ultrasound of inferior vena cava is used by clinician sonographers in intensive care units. Its data can impact clinical decision-making. Subcostal view is a standard view for this issue. A significant proportion of the intensive care unit patients have very difficult approach to this view. In these patients, an alternative view is a transhepatic view, feasible in nearly every intensive care unit patient. Limited data on the ultrasound technique exist in literature.
In this review, we discuss in detail the technical aspects of the inferior vena cava ultrasound technique assessed from the transhepatic view, ultrasound tips, and pitfalls.
A search was performed using PubMed, Google Scholar, EMBASE, and Scopus databases with the terms "inferior vena cava ultrasound," "transhepatic view," "right mid-axillary view," "right lateral intercostal view," "ultrasound technique," "inferior vena cava pitfalls," and inferior vena cava ultrasound tips," "intensive care unit." The latest articles were reviewed and this review was written using the most current information.
A standardised ultrasound approach from mid-axillary line provides optimal image acquisition. When there are difficulties finding inferior vena cava or in obesity alternative approaches should be used. Potential pitfalls during acquisition are: misidentifying the inferior vena cava; technical issues in inferior vena cava measurements; utility of the inferior vena cava data in isolation.
Mastering the ultrasound technique from the transhepatic view offers clinicians the opportunity to perform inferior vena cava ultrasound, even in the most challenging patients. Awareness of potential pitfalls and knowledge how to avoid them is important to intensive care unit clinicians to avoid wrong decisions at the bedside.
重症监护病房的临床超声医师会使用下腔静脉床边超声检查。其数据会影响临床决策。肋下视图是该检查的标准视图。相当一部分重症监护病房患者很难获取此视图。对于这些患者，另一种视图是经肝视图，几乎在每位重症监护病房患者中都可行。文献中关于超声技术的数据有限。
在本综述中，我们详细讨论从经肝视图评估下腔静脉超声技术的技术要点、超声检查技巧及陷阱。
使用PubMed、谷歌学术、EMBASE和Scopus数据库进行检索，检索词为“下腔静脉超声”“经肝视图”“右腋中线视图”“右外侧肋间视图”“超声技术”“下腔静脉陷阱”“下腔静脉超声检查技巧”“重症监护病房”。对最新的文章进行了综述，并使用最新信息撰写了本综述。
从中腋线进行标准化超声检查可提供最佳图像采集。当难以找到下腔静脉或患者肥胖时，应采用其他方法。采集过程中的潜在陷阱包括：误认下腔静脉；下腔静脉测量中的技术问题；孤立使用下腔静脉数据的效用。
掌握经肝视图的超声技术为临床医生提供了进行下腔静脉超声检查的机会，即使是在最具挑战性的患者中。了解潜在陷阱以及如何避免这些陷阱对于重症监护病房的临床医生避免床边错误决策非常重要。
