Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

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.

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

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2013.10.001 ◽

2014 ◽

Vol 32 (1) ◽

pp. 78-81 ◽

Cited By ~ 21

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

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Is chest X-ray still necessary after central venous catheter insertion?*

Critical Care Medicine ◽

10.1097/ccm.0b013e3181bfeb45 ◽

2010 ◽

Vol 38 (2) ◽

pp. 715-716 ◽

Cited By ~ 6

Author(s):

Christine Ammirati ◽

Julien Maizel ◽

Michel Slama

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

X Ray ◽

Chest X Ray

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Ultrasound to Detect Central Venous Catheter Placement Associated Complications

Anesthesiology ◽

10.1097/aln.0000000000003126 ◽

2020 ◽

Vol 132 (4) ◽

pp. 781-794 ◽

Cited By ~ 1

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

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

The Journal of Vascular Access ◽

10.5301/jva.5000101 ◽

2012 ◽

Vol 14 (1) ◽

pp. 97-98 ◽

Cited By ~ 2

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

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

Critical Care ◽

10.1186/cc13319 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P129 ◽

Cited By ~ 1

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

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Ultrasonography for Detection of Misplaced Central Venous Catheter: Is Chest X-ray Necessary?

International Journal of Perioperative Ultrasound and Applied Technologies ◽

10.5005/jp-journals-10027-1022 ◽

2012 ◽

Vol 1 ◽

pp. 105-106 ◽

Cited By ~ 1

Author(s):

Sunny Malik ◽

Praveen Kumar Verma ◽

Itee Chowdhury ◽

Mamta Dubey

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

X Ray ◽

Chest X Ray

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

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0041-1723747 ◽

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.

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Ultrasonography Versus Chest X-Ray to Confirm Proper Placement of Central Venous Catheter

Iranian Journal of Radiology ◽

10.5812/iranjradiol.100437 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Mehrnaz Nikouyeh ◽

Kiandokht Khorshidi ◽

Mohammad Hassan Rouzegari ◽

Rabee Sarram

Keyword(s):

Central Venous Catheter ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Underlying Disease ◽

Central Venous ◽

X Ray ◽

Comparison Results ◽

Chest X Ray ◽

The Right

Background: Central venous catheter (CVC) is located within the proximal third of the superior vena cava, inferior vena cava, or the right atrium. The confirmation of right location of catheter’s tip is done by chest X-ray (CXR) routinely. Objectives: In this study, we compared the proper location of the tip of the catheter by ultrasonography with CXR. Patients and Methods: One hundred and seventeen patients were included in this study. The CVC was placed according to the underlying disease. The proper location of the catheter was checked by ultrasonography and then CXR was carried out. The results of both methods were recorded and finally the statistical analysis was performed for comparison. Results: The tip of the catheter was observed by ultrasonography in 111 patients, but in the six other ones, the tip of the catheter was not observed by ultrasonography and observed in CXR. Therefore, the sensitivity of ultrasonography was 94.9 % in this study. Conclusion: The results showed that ultrasonography shows the catheter in 94.9% of the cases, although the risk of exposure to X-ray does not exist. The cost and time for evaluation of the tip of the catheter is significantly less by using ultrasonography compared to CXR.

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‘Transvenous’ pleurocentesis

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919869779 ◽

2019 ◽

Vol 27 (5) ◽

pp. 313-315

Author(s):

Kelvin Shenq Woei Siew ◽

Huynh Quoc Hieu ◽

Alexander Loch

Keyword(s):

Central Venous Catheter ◽

Fluid Resuscitation ◽

Venous Catheter ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

X Ray ◽

Aged Woman ◽

Appropriate Treatment ◽

Middle Aged Woman ◽

Chest X Ray

A middle-aged woman had a central venous catheter insertion for fluid resuscitation presented with tachypnea and oxygen desaturation 6 h later. Diagnosis was made based on the chest X-ray performed 6 h after the catheter placement. Thereafter, the patient received appropriate treatment.

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