Confirmation of endovenous placement of central catheter using the ultrasonographic \"bubble test\"

Abstract

Insertion of central venous catheter (CVC) is the most common procedure to be performed in Intensive Care Units. Addition of ultrasonographic guidance to this procedure, which was initially performed blindly, has improved safety of this procedure. Confirmation of endovenous placement of CVC though, is tricky, as methods for confirmation are either operator dependent, time-consuming or not available at bedside. Prospective observational study was carried out to study feasibility of use of sonobubble test to confirm the presence of CVC within central vein. After insertion of CVC in the internal jugular, subclavian or axillary vein, a 10 ml bolus of shaken saline microbubble is injected through port of CVC, and opacification of right atrium is observed in xiphoid view on ultrasonography. The Sonobubble test was helpful for dynamic confirmation of endovenous placement of CVC and prevented complications such as arterial puncture and cannulation. We recommend its use following CVC insertion.

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

“…A total of 1469 CVC were included in the final analysis with 258 catheter malpositions (17.6%) identified on chest radiography. Two studies could not be analyzed in this meta-analysis because there were no catheter malpositions identified by the index test (44) or the reference test (chest radiography)(35, 41). Subgroup analysis of study operator experience and ultrasound protocol is listed in Supplemental Digital Content 9.…”

Inadvertent Central Arterial Catheterization: An Unusual Cause of Ischemic Stroke

“…[ 16 ] Analysis of pressure waveform and/or gravitational flow using pressure transduction can effectively confirm the venous placement of CVC and has shown to reduce incidences of inadvertent arterial cannulation. [ 13 17 ] Similarly, analysis of arterial blood gas from aspirated blood may provide confirmation arterial catheterization if both pO 2 and SpO 2 are high. [ 13 18 ] Postprocedure chest X-ray further verifies venous placement.…”

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

“…The overall feasibility of the “bubble test” method is 98%; its specificity is 99.5% and its sensitivity 64,9%, but with a wide variability among the studies (33.3%–100%). 28,31–33,38–41…”

“…41 In most studies, the level of competence of the operators is not specifically mentioned. 31,32,38,40…”

“…The technique is simple and absolutely safe for the patient 36,37 : it has been tested in many clinical studies. 17,[31][32][33][34][38][39][40][41][42][43] As in the technique of direct ultrasound visualization, a sector probe is used, and the preferred views are the four-chamber subcostal view and the apical view.…”