Contrast enhanced ultrasound vs chest X-ray to determine correct central venous catheter position

Cortellaro, Francesca; Mellace, Luca; Paglia, Stefano; Costantino, Giorgio; Sher, Sara; Coen, Daniele

doi:10.1016/j.ajem.2013.10.001

Cited by 34 publications

(56 citation statements)

References 19 publications

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“…Our results are in accordance with Cortellaro and co-workers, who reported that CEUS could not substitute for chest radiography; however, their reported sensitivity (33%) was lower than ours (98%) and their reported specificity (98%) was higher than ours (69%) (16). Their low reported sensitivity led them to not recommend CEUS as a triage test.…”

Section: Discussionsupporting

confidence: 92%

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Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

et al. 2016

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BackgroundChest radiography after central venous catheter (CVC) insertion is the main method of verifying the catheter location. Despite the widespread use of radiography for detecting catheter position, x-ray may not always be readily available, especially in the operating room.ObjectivesWe aimed to compare contrast-enhanced ultrasonography (CEUS) and chest radiography for detecting the correct location of CVCs.MethodsOne hundred sixteen consecutive patients with indications for CVC before cardiac surgery were enrolled in this observational study. After catheter insertion, CEUS was performed. Portable radiography was obtained postoperatively in the intensive care unit. Sensitivity, specificity, and predictive values were determined by comparing the ultrasonography results with radiographic findings as a reference standard.ResultsChest radiography revealed 16 CVC misplacements: two cases of intravascular and 14 cases of right atrium (RA) misplacement. CEUS detected 11 true catheter malpositionings in the RA, while it could not recognize seven catheter placements correctly. CEUS showed two false RA misplacements and five falsely correct CVC positions. A sensitivity of 98% and specificity of 69% were achieved for CEUS in detecting CVC misplacements. Positive and negative predictive values were 95% and 85%, respectively. The interrater agreement (kappa) between CEUS and radiography was 0.72 (P < 0.001).ConclusionsDespite close concordance between ultrasonography and chest radiography, CEUS is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored.

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Section: Discussionsupporting

confidence: 92%

“…Considering the population of their study, who were mostly children, their findings are different from ours, which were derived from an adult population. Other researchers also reported more favorable efficacy of CEUS in children (16). …”

Section: Discussionmentioning

confidence: 84%

Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

et al. 2016

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“…Finally, 17 full‐text articles were assessed (with the exception of 1 abstract whose full text could not be retrieved). Four studies and 1 abstract were included in the final analysis, as summarized in Table . All studies were limited to the emergency or ICU setting where a standard contrast‐enhanced US technique was used to determine the correct placement of an internal jugular or subclavian central venous line.…”

Section: Resultsmentioning

confidence: 99%

“…All studies were limited to the emergency or ICU setting where a standard contrast‐enhanced US technique was used to determine the correct placement of an internal jugular or subclavian central venous line. The technique for placement of the central venous catheter was described identically (US‐guided Seldinger technique) in all studies, and all articles described an identical contrast‐enhanced US technique . The US examinations were performed by either emergency physicians or intensivists and confirmed by standard chest radiography done after the US examinations in all studies.…”

Section: Resultsmentioning

confidence: 99%

Use of Contrast‐Enhanced Ultrasound for Confirmation of Central Venous Catheter Placement: Systematic Review and Meta‐analysis

Chebl

Kiblawi

Khuri

et al. 2017

J of Ultrasound Medicine

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“…Other measures that could have been used to confirm catheter position include the use of ultrasound to detect micro bubbles in the right atrium and right ventricle on injection of saline from the newly inserted line [6]. This has been extensively studied and it might have been of benefit in our case.…”

Section: Discussionmentioning

confidence: 99%

Death following removal of a misplaced central venous catheter

2016

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We report the case of a misplaced central venous catheter into the pleural cavity despite the use of ultrasound to aid insertion into the left internal jugular vein. The patient was taking dabigatran for management of embolic complications secondary to atrial fibrillation. Misplacement was undiagnosed despite imaging, and eventually led to severe intrapleural haemorrhage on removal of the line, subsequently leading to death.

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Contrast enhanced ultrasound vs chest X-ray to determine correct central venous catheter position

Cited by 34 publications

References 19 publications

Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

Use of Contrast‐Enhanced Ultrasound for Confirmation of Central Venous Catheter Placement: Systematic Review and Meta‐analysis

Death following removal of a misplaced central venous catheter

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