BACKGROUND: The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation. METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC. RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8% (95%CI 77.1%-93.5%) and specificity of 100% (95%CI 15.8%-100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes (IQR 10-29) and 32 minutes (IQR 19-45), respectively. CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a confirmatory CXR.
BACKGROUND: The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation. METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC. RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8% (95%CI 77.1%-93.5%) and specificity of 100% (95%CI 15.8%-100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes (IQR 10-29) and 32 minutes (IQR 19-45), respectively. CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a confirmatory CXR.
Entities:
Keywords:
Central venous access; Emergency ultrasound; Point-of-care ultrasound
Authors: Petra E Duran-Gehring; Faheem W Guirgis; Kristin C McKee; Susan Goggans; Huynh Tran; Colleen J Kalynych; Robert L Wears Journal: Am J Emerg Med Date: 2014-10-13 Impact factor: 2.469
Authors: Donald M Yealy; John A Kellum; David T Huang; Amber E Barnato; Lisa A Weissfeld; Francis Pike; Thomas Terndrup; Henry E Wang; Peter C Hou; Frank LoVecchio; Michael R Filbin; Nathan I Shapiro; Derek C Angus Journal: N Engl J Med Date: 2014-03-18 Impact factor: 91.245
Authors: Shadi Lahham; Priel Schmalbach; Sean P Wilson; Lori Ludeman; Mohammad Subeh; Jocelyn Chao; Nadeem Albadawi; Niki Mohammadi; John C Fox Journal: World J Emerg Med Date: 2016
Authors: Anthony J Weekes; David A Johnson; Stephen M Keller; Bradley Efune; Christopher Carey; Nigel L Rozario; H James Norton Journal: Acad Emerg Med Date: 2014-01 Impact factor: 3.451
Authors: Jaydev K Dave; Maureen E Mc Donald; Praveen Mehrotra; Andrew R Kohut; John R Eisenbrey; Flemming Forsberg Journal: Ultrasonics Date: 2017-11-23 Impact factor: 2.890
Authors: Enyo A Ablordeppey; Anne M Drewry; Daniel L Theodoro; LinLin Tian; Brian M Fuller; Richard T Griffey Journal: Shock Date: 2019-05 Impact factor: 3.454
Authors: Enyo A Ablordeppey; Adam M Koenig; Abigail R Barker; Emily E Hernandez; Suzanne M Simkovich; James G Krings; Derek S Brown; Richard T Griffey Journal: West J Emerg Med Date: 2022-09-15
Authors: Quincy K Tran; Mark Foster; Justin Bowler; Mia Lancaster; Jennifer Tchai; Katie Andersen; Ann Matta; Daniel J Haase Journal: Heliyon Date: 2020-01-07