Letter to Editor on A Rare Central Venous Catheter Malposition

Lie, Jason; Yadagiri, Manjula; Aspinall, Catherine

doi:10.5812/aapm.20019

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…Various factors accounts for complication risks throughout CVC procedure such as operator skill, necessity of placement, among other patient-related considerations such as obesity, prior difficult cannulation and coagulopathy [3,4]. Despite wide publicity of CVC, this procedure may be accompanied by various complications such as catheter misplacement, pneumothorax, arterial puncture, and hematoma [5][6][7][8][9][10][11]. Furthermore, catheter misplacement may lead to more perilous occurrence such as death; hence localization of catheter is essentially important procedure [12,13].…”

Section: Introductionmentioning

confidence: 99%

Sonography for Localization of Central Venous Catheter Location: A Reliable Alternative to Radiography

Anoosheh¹,

Abbasi²,

Mofìdi³

2017

ASS

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Introduction: Localization of Control Venous Catheter (CVC) is essential in emergency (ER) and ICU settings;accurately confirming of the location of CVC may enable clinician to minimize the risk of the procedure. Radiography and Sonography are two common procedures, which is used for localization of CVC. Due to volatile hemodynamic nature of patients, it is vital to follow CVC procedure and diagnose possible side effects and complications as soon as possible. Aim of current study is to assess efficacy, practicality and procedure time-curve between two aforementioned methods (Sonography Versus Radiography). After CV line preparation. Methodology: In current cross-sectional study we obtained 201 participants via convenient sampling method from Rasoul-E-Akram Hospital, Haftom-E-Tir Hospital and Firoozgar hospital. Participants were chosen from patients older than 18, who were admitted to ER or ICU in aforementioned hospitals and were candidate for CV line preparation. Following CVC procedure, physicians proceeded with radiography and sonography among all patients and compared approaches with respect to, timing, confirmation of catheter location and post CVC complications. Results: The average time of sonography procedure was estimated roughly 2.08 minutes, in which the maximum time was 5.5 minutes and the minimum time was 1.04 minutes. The standard deviation suggested that the sonography time for most of patients was about 2 minutes. Variance of sonography time among the above population was not reported. The data analysis showed that Chest XRay (CXR) time average for studied patients was about 40.82 minutes, in which the minimum time was 10 minutes and the maximum time was 150.15 minutes. The standard deviation of this variable suggested that variance level and CXR time difference among aforementioned patients were high (about 28.2). Bubble was found in the sonography of 199 cases and just two cases were excluded. According to these results, sensitivity of sonography was 99%, specificity was 100% and Kappa coefficient between sonography and radiography was 98%. Conclusion: All in all, with respect to high correlation in accurate localization of CVC in both approaches (radiography and sonography) plus competitive advantage of sonography over radiography by maintaining shorter time in confirmation of CVC location, sonography can be discussed as optimum and routine modality with respect catheter location confirmation in emergency settings.

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Section: Introductionmentioning

confidence: 99%

Sonography for Localization of Central Venous Catheter Location: A Reliable Alternative to Radiography

Anoosheh¹,

Abbasi²,

Mofìdi³

2017

ASS

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Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

et al. 2016

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BackgroundChest radiography after central venous catheter (CVC) insertion is the main method of verifying the catheter location. Despite the widespread use of radiography for detecting catheter position, x-ray may not always be readily available, especially in the operating room.ObjectivesWe aimed to compare contrast-enhanced ultrasonography (CEUS) and chest radiography for detecting the correct location of CVCs.MethodsOne hundred sixteen consecutive patients with indications for CVC before cardiac surgery were enrolled in this observational study. After catheter insertion, CEUS was performed. Portable radiography was obtained postoperatively in the intensive care unit. Sensitivity, specificity, and predictive values were determined by comparing the ultrasonography results with radiographic findings as a reference standard.ResultsChest radiography revealed 16 CVC misplacements: two cases of intravascular and 14 cases of right atrium (RA) misplacement. CEUS detected 11 true catheter malpositionings in the RA, while it could not recognize seven catheter placements correctly. CEUS showed two false RA misplacements and five falsely correct CVC positions. A sensitivity of 98% and specificity of 69% were achieved for CEUS in detecting CVC misplacements. Positive and negative predictive values were 95% and 85%, respectively. The interrater agreement (kappa) between CEUS and radiography was 0.72 (P < 0.001).ConclusionsDespite close concordance between ultrasonography and chest radiography, CEUS is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored.

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Letter to Editor on A Rare Central Venous Catheter Malposition

Cited by 2 publications

References 3 publications

Sonography for Localization of Central Venous Catheter Location: A Reliable Alternative to Radiography

Sonography for Localization of Central Venous Catheter Location: A Reliable Alternative to Radiography

Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

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