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

Kamalipour, H; Ahmadi, Sedigheh; Kamali, Koorosh; Moaref, Alireza; Shafa, Masih; Kamalipour, Parsa

doi:10.5812/aapm.38834

Cited by 13 publications

(14 citation statements)

References 24 publications

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“…Contrast-enhanced US showed 2 false right atrium misplacements and 5 falsely correct CVC positions. They concluded that contrast-enhanced US 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 [50].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 67%

ACR Appropriateness Criteria® Intensive Care Unit Patients

Imaging¹,

Laroia

Donnelly

et al. 2021

Journal of the American College of Radiology

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Chest radiography is the most frequent and primary imaging modality in the intensive care unit (ICU), given its portability, rapid image acquisition, and availability of immediate information on the bedside preview. Due to the severity of underlying disease and frequent need of placement of monitoring devices, ICU patients are very likely to develop complications related to underlying disease process and interventions. Portable chest radiography in the ICU is an essential tool to monitor the disease process and the complications from interventions; however, it is subject to overuse especially in stable patients. Restricting the use of chest radiographs in the ICU to only when indicated has not been shown to cause harm. The emerging role of bedside point-of-care lung ultrasound performed by the clinicians is noted in the recent literature. The bedside lung ultrasound appears promising but needs cautious evaluation in the future to determine its role in ICU patients.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Section: Discussion Of Procedures By Variantmentioning

confidence: 67%

ACR Appropriateness Criteria® Intensive Care Unit Patients

Imaging¹,

Laroia

Donnelly

et al. 2021

Journal of the American College of Radiology

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“…This method's sensitivity and specificity ranges from 68.8%-98% to 97%-100%, respectively. [15][16][17] Weekes et al used non-agitated saline in their two studies (n ¼ 303) with 75% and 100% sensitivity and specificity, respectively. 4,5 Our study is the first to use D50% as a contrast solution in CVC malposition detection.…”

Section: Discussionmentioning

confidence: 99%

“…This method’s sensitivity and specificity ranges from 68.8%–98% to 97%–100%, respectively. 15–17 Weekes et al. used non-agitated saline in their two studies (n = 303) with 75% and 100% sensitivity and specificity, respectively.…”

Section: Discussionmentioning

confidence: 99%

Supradiaphragmatic central venous catheter malposition detection using the parasternal long-axis echocardiographic view and dextrose 50% contrast solution: A pilot study

et al. 2021

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Background Contrast-enhanced ultrasonography (CEUS) using saline was studied to detect supradiaphragmatic central venous catheter malposition. Commonly used echocardiographic views are apical 4-chamber (A4c) and subcostal views. However, this standard method is not feasible in certain situations. We explored the feasibility of the right ventricle inflow parasternal long axis (RVI-PLAX) echocardiographic view and dextrose 50% (D50%) contrast solution for detecting supradiaphragmatic central venous catheter malposition. Method This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush. Results No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators’ diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p < .0001). The RVI-PLAX CEUS was not able to detect two central venous catheter malpositions (one atrial malposition and one left brachiocephalic vein venous catheter malposition). The capillary blood sugar was significantly elevated (8.96 mmol/L vs. 9.75 mmol/L) after D50% flush ( p < 0.005) with no complications reported within 30 minutes after the D50% flush. Conclusion RVI-PLAX view should not be used for guidewire detection. CEUS using D50% and RVI-PLAX view are potentially useful tools in detecting central venous catheter malposition. Further studies comparing them with conventional methods are needed.

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“…First we used the U/S to examine the course of the CVL in the neck to confirm whether the CVL was inserted in the IJ vein or in the carotid artery. Of note, U/S examination of the chest can be used sometimes to localize the tip of CVL; however, it needs an experienced operator and may not detect the final intrathoracic placement of the CVL all the time [ 9 ]. Second, we connected the CVL to a pressure transducer which showed a venous wave form.…”

Section: Discussionmentioning

confidence: 99%