Thread by @GUH_ICU_Anaesth

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Echo Tweetorial 4 - SUBCOSTAL VIEW

1. The subcostal view
2. IVC
3. Additional subcostal views Incredibly versatile TTE view especially in ventilated patients but is trickier than it seems But first - Hand movements!

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So what are we looking at:

3/10 Labelled subcostal image

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Optimise your image as always:
1. Depth
2. Width
3. Gain
4. Focus

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What can the basic subcostal image tell us?

1. RV size - The 'safety net view' - If you think the RV is dilated in suboptimal PLAX or 4Ch views -> the subcostal view will tell you what you need! (2/3 size of LV)
2. RV free wall motion
3. LV function

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Now for the IVC 90 degree anticlockwise turn It is very easy to make mistakes when it comes to IVC measurement and variation, and mistaking it for descending aorta Must see:
1. IVC - leading edges of vessel
2. Hepatic vein
3. IVC entering RA

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Measuring the IVC
1. Make sure it is the IVC(not aorta!)
2. 'Clean edges'
3. 1cm prox to where hepatic vein joins IVC
4. Beware the moving IVC when assessing response during the respiratory cycle
5. M-mode can be used but ensure cursor perpendicular

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Additional Subcostal views:

RVOT - useful for VTI variability We will go into their use in more detail in subsequent tweetorials

9/10 Subcostal SAX: When the PSAX view is difficult try this: It is very useful indeed!

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The subcostal view is the most versatile view in ICU TTE It is more difficult than it looks - subtle hand movements can make big differences so practice!
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