VEXUS (Venous Excess Ultrasound)
IVC Assessment
- Obtain subxiphoid cardiac view: place cardiac probe flat against abdomen and slide towards xiphoid process until see heart.
- While keeping the heart and right atrium centered on the screen, rotate probe marker vertically + lightly angle probe posteriorly.
- Visualize the IVC (enters into the RA, thin walled). Slide side to side to ensure visualizing the intrahepatic IVC at largest diameter.
- Assessment:
- If IVC is less than 2cm = no need to proceed to next steps.
- If IVC is greater than 2cm = proceed to next VEXUS step.
- Note: The video demonstrates an IVC that is greater than 2cm.
Hepatic Vein
- Abdominal probe with probe marker towards head place in right posterior axilalry line.
- Identify hepatic vein (collapsing) + elongate by rotating + heel/rock to make it as vertical as possible.
- Place color doppler (should appear blue = moving away towards IVC). Ensure no speckling (reduce gain till see just the blue).
- Place pulse wave doppler gate in hepatic vein.
- Ask patient to just stop breathing (not hold breath or deep inhale).
- Initiate pulse wave doppler, then freeze image for assessment for severity (see online charts).
Portal vein
- Using abdominal probe slide from hepatic vein position more anteriorly towards front of chest (ie 3cm).
- Identify portal vein + elongate (rotate) + heel/rock (make as vertical as possible).
- Place color doppler (want to see red as blood moving towards the liver/probe). Ensure no speckling (reduce gain till just see red).
- Place pulse wave doppler within portal vein.
- Ask patient to stop breathing (not inhale deeply or hold breath).
- Initiate pulse wave doppler then freeze image for assessment of severity (see online charts).
- Note: The video identifies the portal vein by the bright red color!
Renal Interlobar Vein
- Abdominal probe to posterior axillary line + center kidney on screen, want to find the long axis.
- Center the renal cortex on screen. Click zoom to further visualize.
- Initiate color doppler (increase and decrease gain to visualize small vessels).
- Place pulse wave doppler over vein/artery complex.
- Ask patient to stop breathing (not deep inhale or breath hold).
- Initiate pulse wave doppler tracing + freeze image. Artery (if imaged) will be seen above baseline, vein will be below.
- Assess for severity using online charts.
- Note: The video demonstrates a clear vein/artery complex and so the doppler is placed right on top (getting a bit of artery is okay).
.