title: Location of the Central Venous Catheter Tip With Bedside Ultrasound in Young Children: Can We Eliminate the Need for Chest Radiography?
abstract: OBJECTIVE
  To compare the use of bedside ultrasound and chest radiography to verify central venous catheter tip positioning.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  PICU of a university hospital.
  
  
  METHODS
  Patients aged 0-14 who required a central venous catheter.
  
  
  METHODS
  None.
  
  
  RESULTS
  Central venous catheter tip location was confirmed by ultrasound and chest radiography. Central venous catheters were classified as intra-atrial or extra-atrial according to their positions in relation to the cavoatrial junction. Central venous catheters located outside the vena cava were considered malpositioned. The distance between the catheter tip and the cavoatrial junction was measured. The time elapsed from image capture to interpretation was recorded. Fifty-one central venous catheters in 40 patients were analyzed. Chest radiography and ultrasound results agreed 94% of the time (κ coefficient, 0.638; p < 0.001) in determining intra-atrial and extra-atrial locations and 92% of the time in determining the diagnosis of central venous catheter malposition (κ coefficient, 0.670; p < 0.001). Chest radiography indicated a greater distance between the central venous catheter tip and the cavoatrial junction than measured by ultrasound, with a mean difference of 0.38 cm (95% CI, +0.27, +0.48 cm). Three central venous catheters were classified as extra-atrial by chest radiography but as intra-atrial by ultrasound. To locate the central venous catheter tip, ultrasound required less time than chest radiography (22.96 min [20.43 min] vs 2.23 min [1.06 min]; p < 0.001).
  
  
  CONCLUSIONS
  Bedside ultrasound showed a good agreement with chest radiography in detecting central venous catheter tip location and revealing incorrect positions. Ultrasound could be a preferable method for routine verification of central venous catheter tip and can contribute to increased patient safety.
authors.affiliation: 1Pediatric Critical Care Unit, Department of Pediatrics, Complejo Asistencial Universitario de León, León, Spain. 2Biomedicine Institute of León (IBIOMED), University of León, León, Spain. 3Pediatric Emergency and Critical Care Division, Clinical University Hospital, University of Santiago de Compostela, Institute of Investigation of Santiago (IDIS), Santiago de Compostela, Spain. 4Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Alonso-Quintela
authors.forename: Ignacio
authors.initials: I
authors.lastname: Oulego-Erroz
authors.forename: Silvia
authors.initials: S
authors.lastname: Rodriguez-Blanco
authors.forename: Manoel
authors.initials: M
authors.lastname: Muñiz-Fontan
authors.forename: Santiago
authors.initials: S
authors.lastname: Lapeña-López-de Armentia
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodriguez-Nuñez
mesh_terms: D000293:Adolescent; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011859:Radiography; D014463:Ultrasonography; D014684:Venae Cavae / Q000000981:diagnostic imaging*