Chest radiography for simplified evaluation of central venous catheter tip positioning for safe and accurate haemodynamic monitoring: a retrospective observational study

Abstract

ObjectivesThe tip-to-carina (TC) distance on a simple chest X-ray (CXR) has proven value in the determination of correct central venous catheter (CVC) positioning. However, previous studies have mostly focused on preventing the atrial insertion of the CVC tip, and not on appropriate positioning for accurate haemodynamic monitoring. We aimed to assess whether the TC distance could detect the passage of the CVC tip into the superior vena cava (SVC) and the right atrium (RA), and to accordingly suggest cut-off reference values for these two aspects.DesignRetrospective observational cohort study.SettingSingle urban tertiary level academic hospital.Participants479 patients who underwent CXR and chest CT scan after the insertion of a CVC with a 24-hour interval during the study period.InterventionThe TC distance was measured on CXR, and the position of the CVC tip was assessed on the chest CT images. The TC distance was described as a negative or positive number if the CVC tip was above or below the carina, respectively. Receiver-operating characteristics curve analyses were conducted to ascertain the TC distance to detect SVC entrance and RA insertion of CVC tip.ResultsThe TC distance could significantly detect both SVC entrance and RA insertion (p<0.001 for both; area under curve 0.987 and 0.965, respectively), with a reference range of −6.69 to 15.61 mm.ConclusionThe TC distance in CXR is a simple and precise method to confirm not only the safe placement of the CVC tip but also its optimal positioning for accurate haemodynamic monitoring.

Classification of Central Venous Catheter Tip Position on Chest X-ray Using Artificial Intelligence

“…Postprocedure chest radiograph imaging was not necessary because a chest radiograph is not a reliable test to confirm the tip location, and it has the major disadvantage of being post-procedural [ 14 ]. However, confirmation of tip location by this radiograph remains acceptable practice and is required in the absence of technology used during the procedure [ 14 , 15 , 16 ]. Because of its widespread availability and low cost, it might still be the most common tool for confirming the position of the CVC tip [ 16 , 17 ].…”

“…However, confirmation of tip location by this radiograph remains acceptable practice and is required in the absence of technology used during the procedure [ 14 , 15 , 16 ]. Because of its widespread availability and low cost, it might still be the most common tool for confirming the position of the CVC tip [ 16 , 17 ].…”

“…The vertical distance between the tracheal carina and the CVC tip in CXR could be a simple and precise method to confirm not only the safe placement of the CVC tip but also its optimal positioning for accurate hemodynamic monitoring. [ 16 ] This study aims to develop an algorithm for the automatic classification of the proper depth based on the vertical distance between the tracheal carina and the CVC tip (shallow, proper, and deep position) with the application of automatic segmentation of the trachea and the CVC on chest radiographs using a deep CNN.…”

Assessment of the Tip Position of Central Venous Catheters Inserted Using Peres’ Height Formula

“…Kang et al investigated the tip-to-carina (TC) distance on chest CT and CXR images as many studies have studied [ 18 ]. They have demonstrated CT distance as a simple and precise method to confirm not only the correct placement of the CVC tip but also its optimal position for accurate hemodynamic monitoring.…”

Determination of optimal tip position of peripherally inserted central catheters using electrocardiography: a retrospective study

“…The major differences in the measurement results were resolved through the agreement of investigators after re-measurement, and the averaged data were used for the final analysis. The tipto-carina distance (TCD) was measured using an electronic caliper on CXR and calculated in vertebral body units (VBU), defined as the distance from the inferior endplate of the upper vertebra to the inferior endplate of the lower vertebra [10,[18][19][20]. The area from the CAJ to the lower 1/3 of the SVC was defined as the standard target location of the PICC tip, as reported in the previous studies [9][10][11].…”