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Published:March 21, 2014DOI:https://doi.org/10.1016/j.ajem.2014.02.001
      We are grateful for the comments of Vezzali et al, [
      • Vezzani A.
      • Brusasco C.
      • Corradi F.
      Contrast-enhanced ultrasound to determine correct central venous catheter position.
      ] and we agree with them that a combined method of B-mode and contrast enhanced ultrasonography (CEUS) would help identify the correct position of the Central venous line (CVL) tip. In our study, we checked in B-mode the Seldinger during canulation and before dilatation of the vessel (to avoid complication), and we believe it is also important to check omo- and controlateral neck veins after CVL insertion to identify intravascular malpositioning. Regarding ultrasound evaluation of the tip position of the CVL in the intrathoracic vessels using B-mode, we can see the tip in the neck veins and only few centimeters before the entrance of superior vena cava (SVC) in right atrium (this means that the tip might be anywhere distal the brachiocephalic vein); in our study, CEUS could not differentiate the malpositioning of CVL in brachiocefalic vein as the delay of appearance compared with correct positioning in SVC is not detectable with visual extimation time of bubble appearance in right atrium (RA).
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      Reference

        • Vezzani A.
        • Brusasco C.
        • Corradi F.
        Contrast-enhanced ultrasound to determine correct central venous catheter position.
        Am J Emerg Med. 2014 Feb 4; (pii: S0735-6757(14)00063-1. [Epub ahead of print])https://doi.org/10.1016/j.ajem.2014.01.033