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Figures
Fig. 1
(A) Ultrasound view of the heart in the subxiphoid window during saline flush of distal CVC port. The RA and RV are noted at time 0, at start of saline flush. (B) Microbubbles visible within the RA (bold arrow) and leading into the RV (small arrow) during the saline flush at the 1-second mark indicating CVC tip in correct position in the SVC.
Fig. 2
M-mode tracing of anterior lung slide. (A) M-mode tracing of normal inspiration, visible as “sandy beach sign.” (B) M-mode tracing of PTX, indicated by a horizontal line pattern down the screen.
Abstract
Study objective
The objective was to determine if ultrasound (US) can more rapidly confirm central venous catheter (CVC) position in comparison to chest radiography (CXR) in the emergency department.
Methods
The study included a convenience sample of emergency department patients with supradiaphragmatic CVCs and a CXR for confirmation. Ultrasound was used for CVC confirmation by visualizing microbubble artifact in the right atrium after injection of saline through the distal port. To evaluate for pneumothorax (PTX), “sliding sign” of the pleura was noted on US of the anterior chest. Blinded chart review was performed to assess CXR timing, catheter position and CVC complications. Student's t test was used to compare US time to CXR performance time and radiologist reading time.
Results
Fifty patients were enrolled; 4 were excluded because of inadequate views. Forty-six patients were included in the final analysis. Mean total US time was 5.0 minutes (95% confidence interval [CI], 4.2-5.9) compared to 28.2 minutes (95% CI, 16.8-39.4) for CXR performance with a mean difference of 23.1 minutes (95% CI, −34.5 to −11.8; P < .0002). When comparing only US CVC confirmation time to CXR time, US was an average of 24.0 minutes (95% CI, −35.4 to −12.7; P < .0001) faster. Comparing total US time to radiologist CXR reading time, US was an average of 294 minutes faster (95% CI, −384.5 to -203.5; P < .0000). There were a total of 3 misplaced lines and 2 patients with PTX, all of which were identified correctly on US.
Conclusion
Ultrasound can confirm CVC placement and rule out PTX significantly faster than CXR, expediting the use of CVCs in the critically ill.
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★★Author contributions: PDG, FWG, and KCM conceived the study. PDG, FWG, KCM, SG, TH, and CJK supervised the data collection and chart reviews. RLW, FWG, and CJK provided methodological and statistical advice on study design and data analysis. PDG, FWG, and CJK and RLW drafted the manuscript and all authors contributed substantially to its revision.
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