Ultrasound‐Guided Placement of Central Venous Port Systems via the Right Internal Jugular Vein: Are Chest X‐Ray and/or Fluoroscopy Needed to Confirm the Correct Placement of the Device?

Miccini, Michelangelo; Cassini, Diletta; Gregori, Matteo; Gazzanelli, Sergio; Cassibba, Simone; Biacchi, Daniele

doi:10.1007/s00268-016-3574-2

Cited by 22 publications

(37 citation statements)

References 42 publications

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“…Firstly, we included far more CVC placements (2602 vs 1553) and studies (25 vs 15). Secondly, a strength of our study was that we included studies that used alternative reference standards; TEE, computed tomography, and intra-fluoroscopy were utilized in addition to CXR [ 26 , 27 , 46 ]. Thirdly, our study provides an accurate overview of the various US protocols used and their accuracy.…”

Section: Discussionmentioning

confidence: 99%

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

et al. 2018

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BackgroundInsertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US).MethodsThis is a systematic review and meta-analysis registered at PROSPERO (CRD42016050698). PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Articles which reported the diagnostic accuracy of US in detecting the position of CVCs and the mechanical complications associated with insertion were included. Primary outcomes were specificity and sensitivity of US. Secondary outcomes included prevalence of malposition and pneumothorax, feasibility of US examination, and time to perform and interpret both US and chest x-ray. A qualitative assessment was performed using the QUADAS-2 tool.ResultsWe included 25 studies with a total of 2548 patients and 2602 CVC placements. Analysis yielded a pooled specificity of 98.9 (95% confidence interval (CI): 97.8–99.5) and sensitivity of 68.2 (95% CI: 54.4–79.4). US examination was feasible in 96.8% of the cases. The prevalence of CVC malposition and pneumothorax was 6.8% and 1.1%, respectively. The mean time for US performance was 2.83 min (95% CI: 2.77–2.89 min) min, while chest x-ray performance took 34.7 min (95% CI: 32.6–36.7 min). US was feasible in 97%. Further analyses were performed by defining subgroups based on the different utilized US protocols and on intra-atrial and extra-atrial misplacement. Vascular US combined with transthoracic echocardiography was most accurate.ConclusionsUS is an accurate and feasible diagnostic modality to detect CVC malposition and iatrogenic pneumothorax. Advantages of US over chest x-ray are that it can be performed faster and does not subject patients to radiation. Vascular US combined with transthoracic echocardiography is advised. However, the results need to be interpreted with caution since included studies were often underpowered and had methodological limitations. A large multicenter study investigating optimal US protocol, among other things, is needed.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-1989-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

et al. 2018

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“…There are no standard formulas to predict the exact catheter insertion length, and although the average length in adults via the right IJV is 13 to 16 cm, there are no specific range or average measurements for children. 11,12 However, this study showed an excellent reliability of the estimated catheter tip placement using USG, anatomic landmarks, and EKG monitoring. These data allow us to state that the use of IF could be restricted to selected children, when serious doubts about catheter placements arise, or if symptoms of malposition or migration should occur.…”

Section: Discussionmentioning

confidence: 69%

“…Other authors have studied the need for protocol for chest X-ray or IF for CVP placement in adult patients deeming them unnecessary, resulting in lower cost of the procedure, as well as reducing cumulative radiation dose. 11,13 Miccini et al 11 in 2016 used a formula for estimating catheter length (patient height/10-2 cm) and USG for CVP placement in 304 patients, with catheter malposition encountered in only 4 patients. Wang et al 14 proposed p-wave amplitude monitoring through intracavitary EKG monitoring to improve the accuracy of catheter tip placement without the need of radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Is Intraoperative Fluoroscopy Necessary for Central Venous Port System Placement in Children?

et al. 2018

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Introduction Central venous port (CVP) placement is traditionally performed under fluoroscopy guidance. However, efforts for radiation dose reduction in children have allowed the introduction of ultrasound guidance (USG) and anatomic landmarks as an alternative technique for CVP placement. The aim of this study is to determine whether intraoperative fluoroscopy (IF) is required to confirm the correct position of the catheter tip in children. Patients and Methods A prospective, single-center study was performed between July and December 2017. Standard venous access site was the right internal jugular vein under USG. Estimated catheter length (ECL) was measured using anatomic landmarks. Ideal catheter length (ICL) was measured after placement under fluoroscopy guidance in the same patient. Age, sex, radiation dose, and complications were also analyzed. A t-test for paired samples and intraclass correlation coefficient were performed to analyze results. Results A total of 30 consecutive patients aged 7 ± 2 years underwent CVP placement. The mean ECL was 17.1 ± 1.8 cm, while the mean ICL was 17.7 ± 1.8 cm. The mean difference between measurements was 0.28 cm (95% confidence interval [CI], –0.29 to 0.86; p = 0.324). Intraclass correlation coefficient analysis showed an agreement of 0.95 (95% CI, 0.91–0.98) between measurements. Mean radiation exposure during the procedure was 1.060.78 mGym2 during 0.34 ± 0.6 minutes. There were no complications registered during CVP placement. Conclusion The correlation between IF and USG and anatomically guided catheter tip placement is optimal. These results suggest that fluoroscopy and the radiation exposure it entails can be safely avoided in selected children.

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“…A prospective evaluation of 302 adult patients who underwent elective central venous port system (CVPS) placement through the right internal jugular vein under USG found no unexpected misplacement during intraoperative fluoroscopy that had not been detected with ultrasound (US) before. Intraoperative fluoroscopy only confirmed the correct position of catheters in all cases [10]. So, the authors concluded that the routine use of fluoroscopy is unnecessary.…”

Section: Discussionmentioning

confidence: 90%

Same-day Routine Chest-X Ray After Thoracic Surgery is Not Necessary!

et al. 2017

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Ultrasound‐Guided Placement of Central Venous Port Systems via the Right Internal Jugular Vein: Are Chest X‐Ray and/or Fluoroscopy Needed to Confirm the Correct Placement of the Device?

Abstract: Ultrasonography has resulted in improved safety and effectiveness of port system implantation. The routine use of CXR and IF should be considered unnecessary.

Cited by 22 publications

References 42 publications

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

Is Intraoperative Fluoroscopy Necessary for Central Venous Port System Placement in Children?

Same-day Routine Chest-X Ray After Thoracic Surgery is Not Necessary!

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