scholarly journals Ultrasound to Detect Central Venous Catheter Placement Associated Complications

2020 ◽  
Vol 132 (4) ◽  
pp. 781-794 ◽  
Author(s):  
Jasper M. Smit ◽  
Mark E. Haaksma ◽  
Endry H. T. Lim ◽  
Thei S. Steenvoorden ◽  
Michiel J. Blans ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Diagnostic Accuracy ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Reference Standard ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
X Ray ◽  
Venous Catheterization ◽  
Chest X Ray

Abstract Background Mechanical complications arising after central venous catheter placement are mostly malposition or pneumothorax. To date, to confirm correct position and detect pneumothorax, chest x-ray film has been the reference standard, while ultrasound might be an accurate alternative. The aim of this study was to evaluate diagnostic accuracy of ultrasound to detect central venous catheter malposition and pneumothorax. Methods This was a prospective, multicenter, diagnostic accuracy study conducted at the intensive care unit and postanesthesia care unit. Adult patients who underwent central venous catheterization of the internal jugular vein or subclavian vein were included. Index test consisted of venous, cardiac, and lung ultrasound. Standard reference test was chest x-ray film. Primary outcome was diagnostic accuracy of ultrasound to detect malposition and pneumothorax; for malposition, sensitivity, specificity, and other accuracy parameters were estimated. For pneumothorax, because chest x-ray film is an inaccurate reference standard to diagnose it, agreement and Cohen’s κ-coefficient were determined. Secondary outcomes were accuracy of ultrasound to detect clinically relevant complications and feasibility of ultrasound. Results In total, 758 central venous catheterizations were included. Malposition occurred in 23 (3.3%) out of 688 cases included in the analysis. Ultrasound sensitivity was 0.70 (95% CI, 0.49 to 0.86) and specificity 0.99 (95% CI, 0.98 to 1.00). Pneumothorax occurred in 5 (0.7%) to 11 (1.5%) out of 756 cases according to chest x-ray film and ultrasound, respectively. In 748 out of 756 cases (98.9%), there was agreement between ultrasound and chest x-ray film with a Cohen’s κ-coefficient of 0.50 (95% CI, 0.19 to 0.80). Conclusions This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Evaluation of the Efficacy of Ultrasound in Detecting Correct Placement of Central Venous Catheter and Determining the Elimination of the Need for Chest Radiography

2021 ◽  
Vol 05 (01) ◽  
pp. 018-022
Author(s):  
Suvendu Panda ◽  
S.K. Rojalin Baby ◽  
Rajesh Thosani
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous ◽  
Cross Sectional ◽  
X Ray ◽  
Correct Placement ◽  
Venous Catheterization ◽  
Catheter Tip ◽  
Chest X Ray ◽  
American Society

Abstract Background and Aims Ultrasound guidance of central venous catheter (CVC) insertion improves the safety and efficacy of its placement, but still it may not ensure correct placement of catheter tip. In our study, we aimed to identify the correct placement of CVC tip and to detect mechanical complications, by visualizing it in real time with the help of sonography and comparing this to the chest X-ray findings. Patients and Methods This was a cross-sectional observational study conducted on 80 patients with American Society of Anesthesiologists grades 1 and 2, in the age group of 18 to 65 years, who required central venous catheterization in intensive care unit. The CVC tip placement was identified with ultrasound and then the finding was compared with postinsertion chest X-ray. Results In only 9 out of the 80 patients (11.3%) malposition was detected on ultrasound and was corrected immediately, whereas in remaining 71 patients (88.8%) no intervention was required. It was observed that all the patients had correct position of CVC tip on postprocedural chest X-ray. Accidental arterial cannulation occurred in two (2.5%) patients in whom right internal jugular vein was cannulated and in two (2.5%) patients who had arrhythmia. Conclusion Ultrasonography (USG) examination can be used as a diagnostic tool method for confirmation of CVC tip and identification of cannulation-related complications. Thus, we can say that USG might obviate the need for post-CVC insertion chest X-ray.

scholarly journals Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion

2021 ◽  
Vol 10 (4) ◽  
pp. e001222
Author(s):  
Enyo A Ablordeppey ◽  
Byron Powell ◽  
Virginia McKay ◽  
Shannon Keating ◽  
Aimee James ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Acute Care ◽  
Imaging Modality ◽  
Phase 1 ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
X Ray ◽  
Chest X Ray ◽  
Routine Chest

IntroductionAvoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention.MethodsThe intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion.With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.Trial registration numberClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

2019 ◽  
Vol 21 (4) ◽  
pp. 440-448 ◽  
Author(s):  
Timothy R Spencer ◽  
Amy J Bardin-Spencer
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Clinical Simulation ◽  
Venous Catheterization ◽  
Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

Contrast enhanced ultrasound vs chest X-ray to determine correct central venous catheter position

2014 ◽  
Vol 32 (1) ◽  
pp. 78-81 ◽  
Author(s):  
Francesca Cortellaro ◽  
Luca Mellace ◽  
Stefano Paglia ◽  
Giorgio Costantino ◽  
Sara Sher ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Contrast Enhanced Ultrasound ◽  
Central Venous ◽  
Catheter Position ◽  
X Ray ◽  
Contrast Enhanced ◽  
Chest X Ray

A rare case of central venous catheter malpositioning in polytraumatic patient not recognized by chest x-ray

2012 ◽  
Vol 14 (1) ◽  
pp. 97-98 ◽  
Author(s):  
Simonetta Nataloni ◽  
Andrea Carsetti ◽  
Vincenzo Gabbanelli ◽  
Abele Donati ◽  
Erica Adrario ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Rare Case ◽  
Venous Catheter ◽  
Central Venous ◽  
X Ray ◽  
Chest X Ray

scholarly journals Is chest X-ray necessary after central venous catheter insertion?

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P129 ◽  
Author(s):  
MS Vallecoccia ◽  
F Cavallaro ◽  
M Biancone ◽  
D Settanni ◽  
C Marano ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
X Ray ◽  
Chest X Ray

scholarly journals Coiling of shaft of the central venous catheter inside left subclavian vein- a case report

2018 ◽  
Vol 4 (2) ◽  
pp. 87-90
Author(s):  
Lalit Kumar Rajbanshi ◽  
Shambhu Bahadur Karki ◽  
Batsalya Arjyal
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Guide Wire ◽  
Venous Catheter ◽  
Anatomical Landmarks ◽  
Central Venous ◽  
Venous Catheterization ◽  
Left Subclavian Vein ◽  
The Common ◽  
Blood Aspiration

Central venous catheterization is one of the common procedures used for gaining vascular access for various indications. Sometimes, the catheter can take unusual course inside the vein that can lead to erroneous pressure measurement, increase the risk of thrombosis or trauma to the vessel. Any resistance during insertion of the guide wire or catheter and absence of blood aspiration are some alarming signs that help to detect malposition at the earliest moment. We report a case of coiling of the shaft of the central venous catheter inside left sublacvian vein in a patient with head injury. Technical expertise, sound knowledge of anatomical landmarks and use of real time ultrasound can minimize malposition of the catheter. We suggest at any moment if there is resistance during insertion of guide wire or catheter or if there is absence of blood aspiration from any of the lumen, the catheter should be removed immediately suspecting malposition.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 87-90 

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