Ultrasonographic assessment of the caudal vena cava diameter in cats during blood donation

Abstract

Objectives: Ultrasonography of the caudal vena cava (CVC) has been previously established to assess fluid status in dogs but not in cats. The aim of this study was to determine CVC diameter changes during feline blood donation.

Methods: Inter- and intra-observer variability were assessed in 11 client-owned cats. Minimal and maximal CVC diameters were assessed longitudinally in the subxiphoid view (SV) and right paralumbar view (PV), and transversely in the right hepatic intercostal view (HV). Eighteen client-owned, healthy, anaesthetised cats were evaluated during 21 blood donation procedures of 10 ml/kg in the same anatomical locations before (T0) and after (T1) blood donation, and after volume resuscitation with 30 ml/kg lactated Ringer's solution (T2). The CVC index was calculated.

Results: Intra-observer variability was acceptable for all probe positions, except for the HV, whereas inter-observer variability was considered unacceptable for all probe positions. Complete measurements were obtained during 21 blood donations at T0, T1 and T2 at the SV, during 18/21 blood donations at the HV and during 16/21 blood donations at the PV. At the SV, the minimal CVC diameter between T1 and T2 (P <0.001), and the maximal CVC diameter between T0 and T1 and between T1 and T2 (P <0.001) were significantly different. At the HV, the minimal vertical diameter, maximal vertical diameter and minimal horizontal diameter were different between all timepoints (P <0.001). The maximal horizontal diameter was different between T1 and T2 (P = 0.002). At the PV, both diameters were different between all timepoints (P <0.001). The CVC index was not different between timepoints.

Conclusion and relevance: Significant probe position dependent CVC diameter changes with marked overlap were observed before and after blood donation, and after fluid bolus. No absolute CVC diameter could be used to indicate hypovolaemia. Ultrasonographic assessment of the feline CVC is highly operator-dependent. The CVC index is not useful in cats.

Keywords: Point-of-care ultrasound; hypovolaemia; intravascular volume status; vena cava index.

Figure 1

(a,b) Paralumbar view (PV): the right kidney was identified in a longitudinal view. The transducer was moved backwards and fanned medially until the caudal vena cava (CVC) was identified. Hepatic view (HV): the transducer was placed on the right side, transverse, perpendicular in the ninth or tenth intercostal space ventral to the spinal column. Subxiphoid view (SV): the transducer was placed longitudinally under the xiphoid; the probe was fanned from right to left until the CVC was identified before passing the diaphragm

Figure 2

Measurement of the caudal vena cava (CVC) from the hepatic view in the horizontal and vertical diameters. The horizontal (hor) diameter was assessed at the largest diameter, and the vertical (vert) diameter was assessed perpendicular to it. The CVC is marked in red, and the portal vein is marked in blue

Figure 3

Vertical caudal vena cava diameter during blood donation in the subxiphoid view before (T0) and after (T1) a blood donation of 10 ml/kg and after fluid resuscitation with 30 ml/kg lactated Ringer’s solution (T2). max = maximal; min = minimal; SV = vertical diameter in the subxiphoid view; 0 = T0; 1 = T1; 2 = T2

Figure 4

Vertical caudal vena cava diameter during blood donation in the hepatic view before (T0) and after (T1) a blood donation of 10 ml/kg and after fluid resuscitation with 30 ml/kg lactated Ringer’s solution (T2). max = maximal; min = minimal; HV vert = vertical diameter in the hepatic view; 0 = T0; 1 = T1; 2 = T2

Figure 5

Vertical caudal vena cava diameter during blood donation in the paralumbar view before (T0) and after (T1) a blood donation of 10 ml/kg and after fluid resuscitation with 30 ml/kg lactated Ringer’s solution (T2). max = maximal; min = minimal; PV = vertical diameter in paralumbar view; 0 = T0; 1 = T1; 2 = T2