title: The bubble study: ultrasound confirmation of central venous catheter placement.
abstract: OBJECTIVE
  The objective was to determine if ultrasound (US) can more rapidly confirm central venous catheter (CVC) position in comparison to chest radiography (CXR) in the emergency department.
  
  
  METHODS
  The study included a convenience sample of emergency department patients with supradiaphragmatic CVCs and a CXR for confirmation. Ultrasound was used for CVC confirmation by visualizing microbubble artifact in the right atrium after injection of saline through the distal port. To evaluate for pneumothorax (PTX), "sliding sign" of the pleura was noted on US of the anterior chest. Blinded chart review was performed to assess CXR timing, catheter position and CVC complications. Student's t test was used to compare US time to CXR performance time and radiologist reading time.
  
  
  RESULTS
  Fifty patients were enrolled; 4 were excluded because of inadequate views. Forty-six patients were included in the final analysis. Mean total US time was 5.0 minutes (95% confidence interval [CI], 4.2-5.9) compared to 28.2 minutes (95% CI, 16.8-39.4) for CXR performance with a mean difference of 23.1 minutes (95% CI, -34.5 to -11.8; P < .0002). When comparing only US CVC confirmation time to CXR time, US was an average of 24.0 minutes (95% CI, -35.4 to -12.7; P < .0001) faster. Comparing total US time to radiologist CXR reading time, US was an average of 294 minutes faster (95% CI, -384.5 to -203.5; P < .0000). There were a total of 3 misplaced lines and 2 patients with PTX, all of which were identified correctly on US.
  
  
  CONCLUSIONS
  Ultrasound can confirm CVC placement and rule out PTX significantly faster than CXR, expediting the use of CVCs in the critically ill.
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL. Electronic address: Petra.Duran@jax.ufl.edu.
authors.forename: Petra E
authors.initials: PE
authors.lastname: Duran-Gehring
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors.forename: Faheem W
authors.initials: FW
authors.lastname: Guirgis
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors.forename: Kristin C
authors.initials: KC
authors.lastname: McKee
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors.forename: Susan
authors.initials: S
authors.lastname: Goggans
authors.affiliation: St. Mary Mercy Hospital, St. Joseph Mercy Health System, Department of Internal Medicine, Livonia, MI.
authors.forename: Huynh
authors.initials: H
authors.lastname: Tran
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Kalynych
authors.affiliation: University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wears
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000000981:diagnostic imaging*; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D019095:Point-of-Care Systems; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D025321:Surgery, Computer-Assisted; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*