Bedside Echocardiography

Matthew Gayoso

Finding an Ultrasound

  • MICU: radiology room behind charge nurse's desk in middle hallway
  • VA ICU: In front of resident workspace
  • 8N: Behind nurses' station before entering cleaning supply room
  • 8S: In supply closet to left as your walk toward nursing station - (door code is 1-3-5)
  • 6MCE: COVID restricted (ask nurses)
  • CCU/5N only: supply room on left as entering CCU
  • Round wing: 5th floor, ask nurses

TTE Standard Views

Parasternal Long

  • Probe position: Rotate probe 180 degrees with right edge of probe/probe marker pointing toward pt’s left shoulder
  • Make sure probe is centered over mitral valve (In right spot if you can see MV and AV)

E Point Septal Separation (EPSS)

  • Distance separating the anterior MV leaflet from the septal wall as measure of LV systolic function (easy evaluation of systolic function)
  • Place M mode spike at tip of mitral leaflet and hit M mode (perpendicular to septum)
  • Identify E point (passive filling of LV) and determine distance from interventricular septum (IVS)
    • <7mm = Normal
    • >10mm = HF
  • Confounders that elevate EPSS: AR, MS

Parasternal Short

  • Probe position: Rotate probe 180 degrees with right edge of probe/probe marker pointing toward pt’s left shoulder
  • Good position to assess EF by visualizing wall thickening

Apical Four Chamber

  • Probe position: Slide down and look near pt’s left nipple (or in the intermammary fold after lifting up breast tissue if needed - at PMI if able to palpate
  • Good to assess EF by visualizing cardiac shortening

Subxiphoid

  • Probe position: Push probe head into pt’s abdomen just below xiphoid and flatten probe to make nearly parallel to pt’s position, marker to pt’s left
  • Troubleshooting: shift probe slightly left of midline (toward pt’s right) and angle toward heart/right to use liver as acoustic window or ask pt to take big breath (moves heart closer to probe)
  • Best window to visualize pericardial effusion

IVC

  • Probe position: subxiphoid area with probe marker facing toward pt’s head tilted slightly left of midline, trace IVC into RA to verify correct vessel (vs aorta)
  • IVC size and collapsibility used as a surrogate for CVP and RAP
    • <2.1cm and >50% collapse: RAP ~3 mmHg
    • <2.1cm and < 50% collapse or >2.1cm and >50% collapse: RAP ~8 mmHg
    • >2.1cm, <50% collapse: RAP ~ >15 mmHg
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