objective method for assessment of dry body weight in hemodialysis patient

1. Assessment of volume status via
IVC diameter
By
Dr. Salwa Mahmoud Elwasif, MD
Fellow of Internal Medicine and Nephrology
Urology and Nephrology Center
Mansoura University

2. Agenda
• Case scenario
• Value of using IVC diameter?
• Anatomical background
• technique.
• Interpretation.
• pitfalls.
• Literature.
• Take home massage.

3. Case scenario
• A 71 year-old gentleman
• ESKD on CHD secondary to diabetic nephropathy
• Grade ǁ edema lower limb.
• Hypotension and muscle cramps in the 4th hour of
hemodialysis session necessitate premature
stoppage.

4. Should I give fluid to this patient?

5. indication
• Assessment of intravascular volume state.
• Undifferentiated hypotension or other
scenarios of abnormal volume status , such as
sepsis , dehydration and heart failure.
• Fast , reliable , reproducible and non invasive
method for detection of volume status.

6. Anatomical background

7. Why choosing IVC?

8. • i.v.c physiology:

9. Technique
• We use low frequency probe or abdominal
probe.
• The transducer position is just below the
xiphisternum 1-2 cms to the right of midline
with the marker dot pointing towards the
sternum notch.

12. • M-mode line is placed through the IVC
2-3cms from the junction between IVC and
right atrium or 0.5-1 cm from the junction
of hepatic vien.

14. interperation

18. Can it replace CVP measurement?

21. Pitfalls

35. Literature.

36. Literature.

38. Case scenario
• A 71 year-old gentleman
• ESKD on CHD secondary to diabetic nephropathy
• Grade ǁ edema lower limb.
• Hypotension and muscle cramps in the 4th hour of
hemodialysis session necessitate premature
stoppage.
Lower limb
varicose veins

40. Take home message
• Not all edema and chest crackles are signs of
overload
• Not all muscle cramp is a sign of dehydration
• Justify your diagnosis with available resources