title: Importance of Doppler analysis of transmitted atrial waveforms prior to placement of central venous access catheters.
abstract: OBJECTIVE
  To assess the sensitivity of Doppler flow analysis of the axillary and internal jugular veins to screen for clinically occult thoracic central veno-occlusive disease and predict successful placement of central access catheters.
  
  
  METHODS
  Sixty-seven patients underwent both duplex sonographic evaluation of the axillary and internal jugular veins and contrast venography prior to placement of a central venous catheter. Duplex evaluation included visual evidence of veno-occlusive disease as well as the presence or absence of normal transmitted polyphasic atrial waves and respiratory variation of flow. Diagnostically adequate venograms were available for comparison with the duplex sonograms in 168 access routes (access site plus downstream conduit veins). The contrast venograms and sonograms were compared by using retrospective blinded interpretation. Outcome of attempted catheter placement was tabulated.
  
  
  RESULTS
  Directed sonographic imaging of the axillary and internal jugular vein allowed detection of access route veno-occlusive disease with a sensitivity of only 33.3%. Alternatively, when Doppler flow analysis found atrial waveforms that were not polyphasic, central conduit occlusive disease was detected with a sensitivity of 79.6%. Monophasic atrial waveforms were associated with a 25% failure rate of catheterization due to central vein occlusive disease, whereas polyphasic atrial waveforms were correlated with a 100% success rate for catheter placement.
  
  
  CONCLUSIONS
  In asymptomatic patients, sonographic imaging alone misses most instances of central veno-occlusive disease. However, Doppler flow analysis of transmitted atrial waveforms substantially improved the sensitivity. A normal polyphasic atrial waveform virtually excludes the possibility of a more central venous occlusion or stenosis greater than 80% and ensures an adequate route for central venous catheterization.
authors.affiliation: Department of Radiology, University of California Medical Center, San Diego 92103-8756, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Rose
authors.forename: T B
authors.initials: TB
authors.lastname: Kinney
authors.forename: W P
authors.initials: WP
authors.lastname: Bundens
authors.forename: K
authors.initials: K
authors.lastname: Valji
authors.forename: A C
authors.initials: AC
authors.lastname: Roberts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right / Q000502:physiology*; D001367:Axillary Vein / Q000000981:diagnostic imaging* / Q000502:physiology; D001783:Blood Flow Velocity / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology*; D002405:Catheterization, Central Venous; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011237:Predictive Value of Tests; D012039:Regional Blood Flow / Q000502:physiology; D012119:Respiration; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D003287:Contrast Media