Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department

Neeraja A Nair; Freston Marc Sirur; Vimal Krishnan S

doi:10.1186/s12245-024-00762-7

Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department

Int J Emerg Med. 2024 Nov 28;17(1):181. doi: 10.1186/s12245-024-00762-7.

Authors

Neeraja A Nair¹, Freston Marc Sirur¹, Vimal Krishnan S²

Affiliations

¹ Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, India.
² Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, India. vimal.krishnan@manipal.edu.

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.

Keywords: Emergency Department.; Femoral vein Collapsibility Index; Inferior Vena Cava; POCUS (point of Care Ultrasound); Volume assessment; Volume responsiveness.