title: Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography.
abstract: 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.
authors.affiliation: Anesthesia and Intensive Care Medicine, Hospital of Parma, Parma, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Vezzani
authors.forename: Claudia
authors.initials: C
authors.lastname: Brusasco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Palermo
authors.forename: Claudio
authors.initials: C
authors.lastname: Launo
authors.forename: Mario
authors.initials: M
authors.lastname: Mergoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Corradi
mesh_terms: 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