Agitated Saline Bubble−Enhanced Ultrasound for Assessing Appropriate Position of Hemodialysis Central Venous Catheter in Critically Ill Patients

Passos, Rogério da Hora; Ribeiro, Marlise de Castro; Neves, Júlio Leal Bandeira; Ramos, João Gabriel Rosa; Oliveira, Adelmo Vinicius Lima; Barreto, Zilma; Ferreira, Roseanne; Gomes, Conrado; Batista, Paulo Benígno Pena; Rouby, Jean‐Jacques

doi:10.1016/j.ekir.2017.03.010

Cited by 8 publications

(5 citation statements)

References 14 publications

(20 reference statements)

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“…Our search identified and screened 4071 articles, of which 117 full-text articles were accessed for eligibility (Figure 1). 3,6–11,13,14,17–20,29–57 We retained 41 articles based on prespecified criteria for inclusion (Table 1). Regarding ultrasound guided placement and confirmation methods, 13 articles examined cardiac/vascular methods; 5 examined isolated contrast-enhanced ultrasonography (CEUS); 7 examined isolated rapid atrial swirl sign (RASS); and 13 examined combined/integrated methods (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…POCUS achieves indirect detection by insonating the IJ and SC vein, the heart and/or by incorporating rapid injection of saline or an opacifying agent. 8–11 Zanobetti et al 21 demonstrated that when POCUS is used to examine these major veins and atria post CVC insertion, it has a high sensitivity (Sn) and specificity (Sp) (94% and 89%, respectively), and 82% concordance with CXR. Similarly, Matsushima and Frankel 12 reported a high accuracy (90%), positive predictive value (PPV) (91%) and negative predictive value (NPV) (83%) for detecting CVC misplacement with US.…”

Section: Resultsmentioning

confidence: 99%

“…6,7,9,11,13,14,[16][17][18][19]21,41 When POCUS, rather than CXR, is used, it also means less radiation and shorter delays. 4,5,[9][10][11]17,20,[25][26][27] POCUS added only 30 s to 10 min, whereas CXR added 20-83 min. 9,12,[17][18][19] While there was no evidence that POCUS resulted in better clinical outcomes when compared to CXR, there were no reported downsides, and numerous putative benefits.…”

Section: Discussionmentioning

confidence: 99%

“…These include lower cost, less delay, less radiation, no need to move patients, no need to break the sterile field, and greater accuracy. [1][2][3][4][5][6] We therefore explore the evidence base surrounding POCUS confirmation after upper extremity CVC insertion [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] because it is less well known than that supporting POCUS during insertion, and because it may be time to forego the post insertion CXR. 1,2,4,[22][23][24][25][26][27][28] There has also been comparatively little discussion regarding resistance to change and therefore this is reviewed too.…”

Section: Are Routine Chest Radiographs Still Indicated After Central ...mentioning

confidence: 99%

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Are routine chest radiographs still indicated after central line insertion? A scoping review

Brindley,

Deschamps,

Milovanovic

et al. 2024

Journal of the Intensive Care Society

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Introduction: Central venous catheters are increasingly inserted using point-of-care ultrasound (POCUS) guidance. Following insertion, it is still common to request a confirmatory chest radiograph for subclavian and internal jugular lines, at least outside of the operating theater. This scoping review addresses: (i) the justification for routine post-insertion radiographs, (ii) whether it would better to use post-insertion POCUS instead, and (iii) the perceived barriers to change. Methods: We searched the electronic databases, Ovid MEDLINE (1946-) and Ovid EMBASE (1974-), using the MESH terms (“Echography” OR “Ultrasonography” OR “Ultrasound”) AND “Central Venous Catheter” up until February 2023. We also searched clinical practice guidelines, and targeted literature, including cited and citing articles. We included adults (⩾18 years) and English and French language publications. We included randomized control trials, prospective and retrospective cohort studies, systematic reviews, and surveys. Results: Four thousand seventy-one articles were screened, 117 full-text articles accessed, and 41 retained. Thirteen examined cardiac/vascular methods; 5 examined isolated contrast-enhanced ultrasonography; 7 examined isolated rapid atrial swirl sign; and 13 examined combined/integrated methods. In addition, three systematic reviews/meta-analyses and one survey addressed barriers to POCUS adoption. Discussion: We believe that the literature supports retiring the routine post-central line chest radiograph. This is not only because POCUS has made line insertion safer, but because POCUS performs at least as well, and is associated with less radiation, lower cost, time savings, and greater accuracy. There has been less written about perceived barriers to change, but the literature shows that these concerns- which include upfront costs, time-to-train, medicolegal concerns and habit- can be challenged and hence overcome.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Are Routine Chest Radiographs Still Indicated After Central ...mentioning

confidence: 99%

See 2 more Smart Citations

Are routine chest radiographs still indicated after central line insertion? A scoping review

Brindley,

Deschamps,

Milovanovic

et al. 2024

Journal of the Intensive Care Society

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“…Our group has previously demonstrated that the use of agitated saline bubble–enhanced ultrasound method allows to rapidly ascertain the adequate placement of hemodialysis central venous catheters in patients with life-threatening acute kidney injury. 20 In this study, we have used the same method to confirm proper TDC placement in a series of patients with ESRD. The advantage of our ultrasound-based protocol is that it provides dynamic procedural guidance, as well as evaluation for pneumothorax and confirmation of catheter tip location.…”

Section: Discussionmentioning

confidence: 99%

Agitated saline bubble–enhanced ultrasound for the positioning of cuffed, tunneled dialysis catheters in patients with end-stage renal disease

et al. 2018

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Background: In patients with end-stage renal disease, the use of cuffed, tunneled dialysis catheters for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique. Methods: From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with end-stage renal disease who required tunneled dialysis catheter placement. Results: The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (±0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (±38) mL/min. The total number of catheter days was 7451, with a mean of 133 days and a range of 46-322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively. Conclusion: Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology. Future research should further develop and confirm these initial findings.

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Microbubbles-based drug delivery for antiAlzheimer's drugs

Patel,

Prajapati,

Yadav

2024

Alzheimer's Disease and Advanced Drug Delivery Strategies

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Agitated Saline Bubble−Enhanced Ultrasound for Assessing Appropriate Position of Hemodialysis Central Venous Catheter in Critically Ill Patients

Cited by 8 publications

References 14 publications

Are routine chest radiographs still indicated after central line insertion? A scoping review

Are routine chest radiographs still indicated after central line insertion? A scoping review

Agitated saline bubble–enhanced ultrasound for the positioning of cuffed, tunneled dialysis catheters in patients with end-stage renal disease

Microbubbles-based drug delivery for antiAlzheimer's drugs

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