title: Saline Flush Test: Can Bedside Sonography Replace Conventional Radiography for Confirmation of Above-the-Diaphragm Central Venous Catheter Placement?
abstract: OBJECTIVE
  Resuscitation often requires rapid vascular access via central venous catheters. Chest radiography is the reference standard to confirm central venous catheter placement and exclude complications. However, radiographs are often untimely. The purpose of this study was to determine whether dynamic sonographic visualization of a saline flush in the right side of the heart after central venous catheter placement could serve as a more rapid confirmatory study for above-the-diaphragm catheter placement.
  
  
  METHODS
  A consecutive prospective enrollment study was conducted in the emergency departments of 2 major tertiary care centers. Adult patients of the study investigators who required an above-the-diaphragm central venous catheter were enrolled during the study period. Patients had a catheter placed with sonographic guidance. After placement of the catheter, thoracic sonography was performed. The times for visualization of the saline flush in the right ventricle and sonographic exclusion of ipsilateral pneumothorax were recorded. Chest radiography was performed per standard practice.
  
  
  RESULTS
  Eighty-one patients were enrolled; 13 were excluded. The mean catheter confirmation time by sonography was 8.80 minutes (95% confidence interval, 7.46-10.14 minutes). The mean catheter confirmation time by chest radiograph availability for viewing was 45.78 minutes (95% confidence interval, 37.03-54.54 minutes). Mean sonographic confirmation occurred 36.98 minutes sooner than radiography (P< .001). No discrepancy existed between sonographic and radiographic confirmation.
  
  
  CONCLUSIONS
  Confirmation of central venous catheter placement by dynamic sonographic visualization of a saline flush with exclusion of pneumothorax is an accurate, safe, and more efficient method than confirmation by chest radiography. It allows the central line to be used immediately, expediting patient care.
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Robert
authors.initials: R
authors.lastname: Gekle
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Laurence
authors.initials: L
authors.lastname: Dubensky
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Stephanie
authors.initials: S
authors.lastname: Haddad
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Robert
authors.initials: R
authors.lastname: Bramante
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Angela
authors.initials: A
authors.lastname: Cirilli
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Tracy
authors.initials: T
authors.lastname: Catlin
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Gaurav
authors.initials: G
authors.lastname: Patel
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Jason
authors.initials: J
authors.lastname: D'Amore
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Todd L
authors.initials: TL
authors.lastname: Slesinger
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Raio
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Veena
authors.initials: V
authors.lastname: Modayil
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
authors.forename: Mathew
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D062905:Central Venous Catheters; D006801:Humans; D011030:Pneumothorax / Q000175:diagnosis*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013902:Radiography, Thoracic; D015203:Reproducibility of Results; D012965:Sodium Chloride / Q000008:administration & dosage*; D062606:Tertiary Care Centers; D013909:Thorax / Q000000981:diagnostic imaging; D013997:Time Factors; D018084:Ultrasonography, Interventional
chemical_list: D012965:Sodium Chloride
keywords: emergency; emergency ultrasound; lung; procedural; transthoracic