Contrast enhanced ultrasound as a new tool to estimate the performance of midline catheters in the single patient

Gidaro, Antonio; Casella, Francesco; Lugli, Francesca; Cogliati, Chiara; Calloni, Maria Vittoria; Samartin, Federica; Brena, Nicola; Pace, G.

doi:10.1177/11297298211034629

Cited by 4 publications

(10 citation statements)

References 12 publications

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“…A previous study [22] investigating the "qualitative" bubble test, defined as the complete RA opacization versus "few or no bubbles" detection, reported that the complete opacization of RA occurred in half of the patients with CVC misplacements, claiming its low diagnostic accuracy. Furthermore, another study has questioned the usefulness of the proposed cut-off transition times to confirm central catheters tips position [23].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography

et al. 2022

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Background To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. Methods A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. Results As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view. Conclusions The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.

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Section: Discussionmentioning

confidence: 99%

Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography

et al. 2022

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“…When the microbubbles test is applied to central catheters, a 2 s cut-off is routinely used to confirm a correct tip location 7 (RA—superior vena cava junction). However, a recent paper evaluating peripheral midline catheters, 8 measured a MBT < 2 s in 29.4% of patients, implying that 2 s may not represent a suitable cut-off to confirm the CVC correct tip location. Such finding is in line with the studies published by Meggiolaro et al 9 and Iacobone et al 5 that suggest a MBT much lower than 2 s (respectively 500–1000 ms) for CVC correct location.…”

Section: Introductionmentioning

confidence: 97%

“…The detection of MES by means of PW is easier than microbubble B-mode visualization, and time delay between infusion and MES detection is objectively measurable on the PW spectrum, even after test conclusion by means of recorded frames, as previous established also in standard MBT. [5][6][7][8][9] The first aim of this pilot study is to establish agreement of MBT with PW test (MBT-PW) compared with reference standard IC-ECG and standard MBT for tip location. Ultrasound tip location through MBT and MBT PW were performed after that the correct catheter's position was confirmed with reference standard IC-ECG.…”

Section: Introductionmentioning

confidence: 99%

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Pulsed-wave Doppler for ultrasound-based tip location using bubble test: A pilot study

et al. 2022

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Background: MicroBubbles Time test (MBT), consisting in the rapid infusion of saline with addition of air microbubbles, visualized by B-mode echocardiography, represents a potential alternative to Intracavitary ECG (IC-ECG) and chest X-ray for central venous catheters (CVCs) tip location. Even if promising, this technique lacks of standardization: a clear time cut-off between bubble infusion and their detection in heart’s right chambers hasn’t been yet established. At these regard, microbubbles could be also detected as microembolic signals (MES) with an alternative ultrasound technique: the pulse wave Doppler (PW). Objective and methods: The first aim of this pilot study is to establish agreement of MBT with PW test (MBT-PW) compared with reference standard IC-ECG and normal MBT for tip location on CVCs. Corrected tip’s position was established through reference standard IC-ECG, afterward MBT-PW was performed, with the sample volume placed at tricuspid valve to detect MES simultaneously with micro-bubbles injection in CVCs. The second aim was to evaluate inter-observer variability for MES detection and grading. Results: Eight patients were enrolled; we obtained three records for each patients (24 with MBT and 24 with MBT-PW, the two techniques were acquired simultaneously). Inter-methods agreement through reference standard IC-ECG versus MBT-PW and MBT versus MBT-PW methodic was satisfying (Cohen’s kappa value = 1). MBT-PW and MBT signals were recorded within the first heart beat after microbubble infusion in all patients. Mean time delay thorough MBT-PW and MBT was 0.76 ±0.07 and 0.78 ± 0.07 s respectively; Intraclass correlation coefficient was 0.992 (95% CI: 0.981–0.996) suggesting excellent correlation. Inter-observer variability for positive MBT-PW evaluation was optimal (Cohen’s kappa value was 1), while indicated substantial agreement for MES grade evaluation (Fleiss’ Kappa value was 0.704; 95% CI: 0.328–1.000). Conclusions: Our study supports agreement between MBT-PW and reference standard IC-ECG for tip location. Satisfactory agreement was observed also for MBT-PW and MBT.

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“…Although a chest X-ray (CXR) is not capable of adequately confirming correct CVC positioning, it is still partially recommended by the ASA and is carried out in most hospitals, serving as a gold standard [ 5 , 12 , 13 ]. A microbubbles test (MBT) is another modality, and it has proven to be able to verify correct CVC positioning [ 2 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. In an MBT, after the rapid injection of a saline air mixture into the CVC, the result of this manoeuvre is observed in transthoracic echocardiography (TTE) images.…”

Section: Introductionmentioning

confidence: 99%

A Simple and Safe Method for Checking the Position of Central Venous Catheters—A New and Reliable Threshold for Right Atrial Swirl Sign in Microbubbles Tests

Ley,

Ghofrani,

Klingenberger

et al. 2024

JCM

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Background: Central venous catheters (CVCs) are indispensable tools in intensive care and emergency medicine. CVC malpositions still occur frequently and can cause various complications leading to increased patient mortality. A microbubbles test (MBT) can be used to confirm correct CVC positioning. However, there is serious doubt regarding whether the currently applied threshold of a 2 s push-to-bubbles time (PTB time) for rapid atrial swirl sign (RASS) in an MBT is reliable and accurate. The aim of the present study was to prove the quality of a new threshold: 1 s. Methods: Consecutive patients who were admitted to the intensive care unit (ICU) in a German neurological specialist hospital from 1 March 2021 to 20 July 2022 were enrolled. After ultrasound-guided CVC insertion, an MBT was performed, PTB time was measured, and RASS was interpreted. Additionally, a chest X-ray (CXR) was requested to check CVC position. Results: A total of 102 CVCs (98% jugular and 2% subclavian) were inserted in 102 patients (38% female and 62% male; median age: 66 years). Negative RASS (PTB time > 1 s) was observed in 2 out of 102 patients, resulting in an echocardiographic malposition rate of 2.0%. CXR confirmed the echocardiographic results. After correcting CVC position in the initially malpositioned CVCs, the PTB time was <1 s (positive RASS). The MBT protocol took about 0.5 min on average, while the CXR results were all available within 30 min. Sensitivity, specificity, and positive and negative predictive value were each 100% for the detection of CVC malpositions via an MBT using a threshold of 1 s compared to CXR. Conclusions: A new threshold of a 1 s PTB time for RASS in an MBT could detect CVC malpositions with excellent quality compared to CXR. Since the MBT was fast and safe and could be performed at the bedside, we propose that an MBT with the new and reliable threshold of 1 s should be routinely used in patient care.

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Contrast enhanced ultrasound as a new tool to estimate the performance of midline catheters in the single patient

Cited by 4 publications

References 12 publications

Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography

Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography

Pulsed-wave Doppler for ultrasound-based tip location using bubble test: A pilot study

A Simple and Safe Method for Checking the Position of Central Venous Catheters—A New and Reliable Threshold for Right Atrial Swirl Sign in Microbubbles Tests

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