Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography.
OBJECTIVE
To determine the usefulness of ultrasound to evaluate central venous catheter misplacements and detection of pneumothorax, thus obviating postprocedural radiograph. After the insertion of a central venous catheter, chest radiograph is usually obtained to ensure correct positioning of the catheter tip and detect postprocedural complications.


METHODS
Prospective observational study.


METHODS
Adult intensive care unit.


METHODS
111 consecutive patients undergoing central venous catheter positioning, using a landmark technique and contrast-enhanced ultrasonography.


RESULTS
A postprocedural chest radiograph was obtained for all patients and was considered as a reference technique. At the end of the procedure, a B-mode ultrasonography was first performed to assess catheter position and detect pneumothorax. Right atrium positioning was detected in 19 patients by ultrasonography, and an additional six by contrast enhanced ultrasonography. Combining ultrasonography and contrast enhanced ultrasonography yielded a 96% sensitivity and 93% specificity in detecting catheter misplacement. Concordance was 95% and kappa value was 0.88 (p < .001). Pneumothorax was detected in four patients by ultrasonography and in two by chest radiograph (concordance = 98%). The mean time required to perform ultrasonography plus contrast enhanced ultrasonography was 10 +/- 5 mins vs. 83 +/- 79 mins for chest radiograph (p < .05).


CONCLUSIONS
The close concordance between ultrasonography plus contrast enhanced ultrasonography and chest radiograph justifies the use of sonography as a standard technique to ensure the correct positioning of the catheter tip and to detect pneumothorax after central venous catheter cannulation to optimize use of hospital resources and minimize time consumption and radiation. Chest radiograph will be necessary when sonographic examination is impossible to perform by technical limitations.
Vezzani
Antonella
A
Anesthesia and Intensive Care Medicine, Hospital of Parma, Parma, Italy.
Brusasco
Claudia
C
Palermo
Salvatore
S
Launo
Claudio
C
Mergoni
Mario
M
Corradi
Francesco
F
D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D013997:Time Factors; D018084:Ultrasonography, Interventional