Using Ultrasound to Identify the Central Venous Catheter Tip in the Superior Vena Cava

Killu, Keith; Parker, Alton; Coba, Victor; Horst, Mathilda; Dulchavsky, Scott A.

doi:10.1177/1944451610378131

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…The advantage of bedside ultrasonography is the immediate availability and nonradiating imaging to identify cardiac structures, intrathoracic and intra-abdominal vasculature prior to and during placement of CVC. Killu et al 14 have described the identification of CVC artifact within the SVC as confirmation of proper CVC placement. Vezzani et al, 15 in a prospective diagnostic study, demonstrated that the sensitivity and specificity of ultrasound detection of catheter misplacement could be as high as 96% and 93%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Postprocedural sonographic lung assessment for detection of occult pneumothorax and prompt placement identification has been described in the field of emergency medicine and critical care medicine. 14,15 Routinely, a chest X-ray is performed immediately after the procedure and it is possible to miss small volume pneumothorax or pneumothorax over posterior or medial locations. Ultrasound is found to be superior in diagnosing even small volume pneumothorax when compared with chest X-ray.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound Diagnosis of Central Line Guidewire Entrapment With an Inferior Vena Cava Filter

et al. 2011

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Introduction. Guidewire entrapment with an inferior vena cava (IVC) fi lter during internal jugular vein central line placement is a rare complication. The diagnosis is made by abdominal X-ray or fl uoroscopy, and in the majority of cases, the guidewire is removed by interventional radiology, seldom requiring operative removal. Objective. To describe a case of diagnosing central line guidewire entrapment with an IVC by bedside ultrasound. Data source/Case summary. During the placement of a central venous catheter (CVC) in a 63-year-old man-on postoperative day 7 from small bowel resection with presumed peripherally inserted central catheter sepsis-the authors were unable to remove the guidewire. Bedside ultrasound was used to quickly identify the guidewire entrapment down the IVC to the IVC fi lter. Conclusion . Bedside ultrasound may aid in the diagnosis and expedite the management of guidewire entrapment with IVC fi lter, which is on the CVC placement complications . G uidewire entrapment with inferior vena cava (IVC) fi lter is one of the rare complications that have been reported in the literature during CVC placement, pulmonary artery catheter placement, or during various intravascular interventional procedures. 1 -4 In US hospitals, millions of central venous catheters (CVCs) are inserted yearly with reported complications ranging from 5% to 19%. 5 Every year about 30 000 IVC fi lters are placed in the United States, when anticoagulation is contraindicated or for occurrence or recurrence of a pulmonary embolus (PE) even in presence of anticoagulation. 6 , 7 With the increasing incidence of CVC and IVC fi lter placements, reporting the occurrence of guidewire entrapment has increased. 8 , 9We report a case of guidewire entrapment in an IVC fi lter during CVC placement and describe how bedside ultrasound aided in the diagnosis and prompted timely intervention. Case SummaryA 63-year-old man-on postoperative day 7 from small bowel resection, gastric feeding tube placement, and incisional hernia repair with a mesh placement-was transferred to the surgical intensive care unit (SICU) for a presumed peripherally inserted central catheter (PICC) line sepsis. Past medical and surgical history included the following: bilateral lower extremity deep vein thrombosis, atrial fi brillation, IVC fi lter placement for high risk of PE, superior mesenteric artery embolization complicated by small bowel ischemia and bowel resection. Following his arrival in SICU, blood cultures from peripheral and PICC line were obtained and the PICC line was removed. Placement of a CVC was attempted for hemodynamic monitoring, vascular access, and parenteral nutrition. Under ultrasound guidance, a new left internal jugular vein (IJV) central line placement was attempted. The procedure was done by the SICU resident under supervision using a linear array probe 12 MHz and a curvilinear array probe (z.one ultra system,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound Diagnosis of Central Line Guidewire Entrapment With an Inferior Vena Cava Filter

et al. 2011

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“…The hepatic vein junction to IVC and the IVC junction to right atrium are confirmatory landmarks. Reproduced with permission from Killu et al [ 26 ].…”

Section: Figurementioning

confidence: 99%

Focused Real-Time Ultrasonography for Nephrologists

Kaptein

2017

International Journal of Nephrology

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We propose that renal consults are enhanced by incorporating a nephrology-focused ultrasound protocol including ultrasound evaluation of cardiac contractility, the presence or absence of pericardial effusion, inferior vena cava size and collapsibility to guide volume management, bladder volume to assess for obstruction or retention, and kidney size and structure to potentially gauge chronicity of renal disease or identify other structural abnormalities. The benefits of immediate and ongoing assessment of cardiac function and intravascular volume status (prerenal), possible urinary obstruction or retention (postrenal), and potential etiologies of acute kidney injury or chronic kidney disease far outweigh the limitations of bedside ultrasonography performed by nephrologists. The alternative is reliance on formal ultrasonography, which creates a disconnect between those who order, perform, and interpret studies, creates delays between when clinical questions are asked and answered, and may increase expense. Ultrasound-enhanced physical examination provides immediate information about our patients, which frequently alters our assessments and management plans.

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“…Evaluation of the heart and determining the EF and stroke volume can help identify the cause of hemodynamic instability and if it is cardiac in origin. Obtaining standard views of the heart is relatively easy to do and can be achieved in most patients [20]. Knowledge of image acquisition, interpretation, and the limitation to certain cardiac views taken into consideration can increase the yield of such exams.…”

Section: Introductionmentioning

confidence: 99%

Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit

Killu

Coba

Blyden

et al. 2020

Critical Care Research and Practice

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Objective. The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity. Methods. A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient’s intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others. This was compared with assessment using bedside ultrasound evaluation of the cardiac function, inferior vena cava, lungs, and the internal jugular vein. Applying a numerical scoring system was evaluated by Fisher’s exact testing and multinomial logistic model to predict the volume status based on ultrasound scores and the classification accuracy. Results. 61 patients in the ICU were evaluated. 21 (34.4% of total) patients diagnosed with hypovolemia, and their ultrasound volume score was −4 in 14 (66.7%) patients, −3 in 5 (23.8%) patients, and 0 in 2 (9.5%) patients (p<0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p<0.001). 22 (36.1% of total) patients diagnosed with hypervolemia, and their ultrasound volume score was +4 in 4 (18.2%) patients, +3 in 15 (68.2%) patients, and + 1 in 1 (4.6%) patient (p<0.001). We found a strong association between standard measures and the ultrasound score (p<0.001). Conclusion. Using the SAFE scoring system to identify the IVV status in critically ill patients significantly correlates with the standard measures. A SAFE score of −4 to −2 more likely represents hypovolemia, −1 to +1 more likely represents euvolemia, and +2 to +4 more likely to be hypervolemia.

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Using Ultrasound to Identify the Central Venous Catheter Tip in the Superior Vena Cava

Cited by 7 publications

References 8 publications

Ultrasound Diagnosis of Central Line Guidewire Entrapment With an Inferior Vena Cava Filter

Ultrasound Diagnosis of Central Line Guidewire Entrapment With an Inferior Vena Cava Filter

Focused Real-Time Ultrasonography for Nephrologists

Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit

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