Inferior vena cava is another useful view obtained from position 1
The view is suitable for a quick evaluation of:
– IVC dimension
– IVC dynamics with respiration
– Placement of umbilical catheter in neonates
– IVC dynamics for the optimization of fluid responsiveness
Forced inspiration will push the diaphragm down and will usually facilitate the subcostal approach
The subcostal 4 chamber view is suitable for evaluation of pericardial effusion, pulmonary embolism and global function of both the right and the left ventricle
The pathology will be explained later
It is recommended that you start with the subcostal 4CH view and look slightly to the back of the heart (elevating the tail of the transducer)
When you have identified the IVC entry into the right atrium, rotate the transducer counterclockwise until a longitudinal view of the IVC is displayed and the OM is pointing cranially
In the daily clinical practice it is important to know the blood supply of the heart
Remember the individual variations can be substantial
The FATE position 1, sub-costal 4 chamber view. Observe the similarities, and the differences with respect to biological variation and instrument setting e.g.: gain, TGC, depth and sector angle reflecting individual habits.
The target view is a 4 chamber image showing the structures of the target image, corresponding to the scanning plane illustrated on the torso in the picture
As the RA and RV are placed anteriorly they will appear in the near field and LA and LV appear in the far field
The probe is placed on the skin of the thorax, the yellow fan-like sector (scanning plane) diverges from the probe and intersects the heart
The orientation marker (OM – grey arrow) of the probe is pointing towards the left side of the patient. The OM corresponds to the orientation indicator (OI) on the right side of the screen
To understand how the sector is presented on the screen, imagine that the upper border of the screen is the skin, and the sector diverges from the probe placed on the skin
The blue radius of the sector on the screen corresponds to the blue border of the yellow fan
The red radius of the sector on the screen corresponds to the red border of the yellow fan
The apex of the heart is displayed on the right side of the screen, when the OM is correctly pointing towards the patient’s left shoulder (the right side of the screen)
The structures identified in the FATE position 1 – the subcostal view:
– Liver
– Apex of the heart
– Base of the heart
– RA: Right atrium
– RV: Right ventricle
– LA: Left atrium
– LV: Left ventricle
– IVS: Inter-ventricular septum
– IAS: Inter-atrial septum
