title: Simplified point-of-care ultrasound protocol to confirm central venous catheter placement: A prospective study.
abstract: BACKGROUND
  The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation.
  
  
  METHODS
  We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC.
  
  
  RESULTS
  Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8% (95%CI77.1%-93.5%) and specificity of 100% (95%CI15.8%-100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes (IQR 10-29) and 32 minutes (IQR 19-45), respectively.
  
  
  CONCLUSIONS
  Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a confirmatory CXR.
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Assaf
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Lahham
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Subeh
authors.affiliation: Department of Emergency Medicine, University of California, Sylmar, Los Angeles, California 91342, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Chiem
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Shwe
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Nguyen
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Fox
keywords: Central venous access; Emergency ultrasound; Point-of-care ultrasound