title: Contrast enhanced ultrasound vs chest x-ray to determine correct central venous catheter position.
abstract: OBJECTIVE
  We aimed to analyze the diagnostic accuracy of contrast enhanced ultrasonography (CEUS), compared with chest x-ray (CXR), in the detection of correct central venous line (CVL) placement. Our hypothesis was to verify whether CEUS could substitute CXR as a reference standard for correct placement of CVL or function as a triage test to limit the execution of CXR only for selected patients.
  
  
  METHODS
  CEUS was carried out in 71 non consecutive patients to verify the correct positioning of a central venous line. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of CEUS compared to CXR, with their respective 95% confidence interval (CI), were calculated.
  
  
  RESULTS
  CXR identified 6 CVL misplacements (8,4%, CI 95% 3,2%-18%). Four of these were intravascular and 2 in the right atrium. CEUS identified only 3 misplacements, of which 1 was intravascular and 2 intracardiac. Using CXR as a reference standard, and considering intravascular and intracardiac malpositioning altogether, the sensitivity, specificity, and positive and negative likelihood ratio of CEUS were 33% (95% CI, 0%-71%), 98% (95% CI, 95%-100%), 21%, 7%, 0%, and 68%, respectively. The negative and positive predictive values were 94% (95% CI, 89%-100%) and 67% (95% CI, 13%-100%).
  
  
  CONCLUSIONS
  CEUS can't substitute CXR, or become a triage test in selected patients, in evaluating the correct tip position after CVL placement.
authors.affiliation: Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy. Electronic address: francesca.cortellaro@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cortellaro
authors.affiliation: Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Mellace
authors.affiliation: Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Paglia
authors.affiliation: Unità Operativa di Medicina a indirizzo fisiopatologico, Dipartimento di Medicina Interna, Ospedale Sacco, Milano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Costantino
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Sher
authors.affiliation: Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Coen
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media