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

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#IVTEAM #Intravenous literature: Cortellaro, F., Mellace, L., Paglia, S., Costantino, G., Sher, S. and Coen, D. (2013) Contrast enhanced ultrasound vs chest X-ray to determine correct central venous catheter position. The American Journal of Emergency Medicine. October 9th. [epub ahead of print].

Abstract:

PURPOSES: We aimed to analyze the diagnostic accuracy of contrast enhanced ultrasonography (CEUS), compared with chest x-ray (CXR), in the detection of correct central venous line (CVL) placement. Our hypothesis was to verify whether CEUS could substitute CXR as a reference standard for correct placement of CVL or function as a triage test to limit the execution of CXR only for selected patients.

BASIC PROCEDURES: CEUS was carried out in 71 non consecutive patients to verify the correct positioning of a central venous line. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of CEUS compared to CXR, with their respective 95% confidence interval (CI), were calculated.

MAIN FINDINGS: CXR identified 6 CVL misplacements (8,4%, CI 95% 3,2%-18%). Four of these were intravascular and 2 in the right atrium. CEUS identified only 3 misplacements, of which 1 was intravascular and 2 intracardiac. Using CXR as a reference standard, and considering intravascular and intracardiac malpositioning altogether, the sensitivity, specificity, and positive and negative likelihood ratio of CEUS were 33% (95% CI, 0%-71%), 98% (95% CI, 95%-100%), 21%, 7%, 0%, and 68%, respectively. The negative and positive predictive values were 94% (95% CI, 89%-100%) and 67% (95% CI, 13%-100%).

PRINCIPAL CONCLUSIONS: CEUS can’t substitute CXR, or become a triage test in selected patients, in evaluating the correct tip position after CVL placement.

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