Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe

Kim, Se-Chan; Heinze, Ingo; Schmiedel, A; Baumgarten, Georg; Knuefermann, Pascal; Hoeft, Andreas; Weber, Stefan

doi:10.1097/eja.0000000000000042

Cited by 41 publications

(45 citation statements)

References 23 publications

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“…In a previously published study, chest radiographs were obtained in all patients following ultrasound guided CVC placement 8 . The CVC tip position in relation to the carina on chest radiographs was analysed by a radiologist who confirmed a correct position of the CVC in the lower SVC in all investigated patients.…”

Section: Representative Resultsmentioning

confidence: 99%

“…In 8% of the study population the J-tip was not visible in proximity of the right pulmonary artery. However, we did not test if a sagittal view would allow a better visualisation 8 .…”

Section: Representative Resultsmentioning

confidence: 99%

“…The right supraclavicular fossa ultrasound view has been solely described for diagnostic purposes in cardiac failure. In a pilot study, we have demonstrated that this view can also be safely used for venipuncture of the right IJV and accurate positioning of the CVC guidewire with subsequent CVC placement in real-time 8 . The right supraclavicular fossa ultrasound view can be established with a microconvex probe which has the advantage of a small footprint, deep pentetration and, yet a sufficient resolution for venipuncture when compared to a linear probe [8][9][10] .…”

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confidence: 98%

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The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire

Kim

Klebach

Heinze

et al. 2014

JoVE

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The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under realtime ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training. Video LinkThe video component of this article can be found at

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Section: Representative Resultsmentioning

confidence: 99%

“…In 8% of the study population the J-tip was not visible in proximity of the right pulmonary artery. However, we did not test if a sagittal view would allow a better visualisation 8 .…”

Section: Representative Resultsmentioning

confidence: 99%

mentioning

confidence: 98%

See 1 more Smart Citation

The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire

Kim

Klebach

Heinze

et al. 2014

JoVE

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“…Studies have used surface landmarks, 7 real time or postoperative chest X-rays, 8 electrocardiograms, 9,10 or transthoracic echocardiograms to indirectly assess the appropriate depth of catheter tips. 11 Transesophageal echocardiography (TEE) is used to monitor patients in cardiac surgery and patients with cardiac diseases undergoing high-risk noncardiac surgeries. In addition to being able to provide information on heart function, valvular disease, blood volume, and myocardial ischemia, TEE can be used to accurately guide the CVC tip to the ideal intravascular position because the lower section of superior vena cava and the right atrium can be clearly seen in the midesophageal bicaval TEE view ( Figure 1).…”

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confidence: 99%

Determination and prediction of the appropriate depth of right internal jugular vein catheterization via the middle approach in adults using transesophageal echocardiography

Sun

Feng

2019

Echocardiography

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Purpose The appropriate depth of right internal jugular venous (RIJV) catheterization is still under debated. In this study, transesophageal echocardiography (TEE) is used to develop a prediction formula for fixed RIJV catheter depth. Methods Eighty patients with indications for intraoperative TEE and central line placement were enrolled. After intubation, a RIJV catheter was inserted via the middle approach using the Seldinger technique. When the J‐tip of the guide wire appeared at the junction of the superior vena cava and the right atrium under TEE guidance, the guide wire was pulled back by approximately 2‐3 cm, until its tip was out of the pericardial fold. This depth was regarded as the insertion depth of the central venous catheter. Body landmark distance was measured, and the prediction formula was generated. Results The mean central line depth after TEE‐guided placement was 15.1 ± 1.7 cm. The prediction formula developed is as follows: Insertion depth = (Height ÷ 20) + (D ÷ 2), where D equals the distance from the insertion point to the sternal angle via the right sternoclavicular joint (r = 0.595, r2 = 0.354, P < 0.01). Conclusions TEE is an effective method for determining the appropriate insertion depth for an RIJV catheter. The prediction formula can be used as a reference for future RIJV catheterizations via the middle approach.

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“…Recent anesthesiology literature has demonstrated feasibility of central line placement with a combination of guided placement followed by transesophageal echocardiography to fully evaluate the position of the catheter tip within the superior vena cava. Such literature is promising; however, the procedure is invasive and difficult to perform in the emergency setting 9 …”

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confidence: 99%

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Gekle

Dubensky²,

Haddad

et al. 2015

J of Ultrasound Medicine

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Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe

Abstract: Ultrasound via a right supraclavicular view is a feasible, well tolerated and accurate approach and should be further explored. Chest radiography confirmed CVC position in the lower SVC.

Cited by 41 publications

References 23 publications

The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire

The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire

Determination and prediction of the appropriate depth of right internal jugular vein catheterization via the middle approach in adults using transesophageal echocardiography

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