Study suggests alternative to routine chest radiograph for central venous catheter tip position

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#IVTEAM #Intravenous literature: Wen, M., Stock, K., Heemann, U., Aussieker, M. and Küchle, C. (2013) Agitated Saline Bubble-Enhanced Transthoracic Echocardiography: A Novel Method to Visualize the Position of Central Venous Catheter. Critical Care Medicine. December 5th. [epub ahead of print].

Abstract:

OBJECTIVES: The purpose of this study is to describe a novel method to visualize the position of central venous catheters, which is safe, expeditious, and less expensive than the routine postprocedural chest radiograph.

DESIGN: Retrospective comparative study.

SETTING: Dialysis Center of the Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

PATIENTS: Two hundred and two adult patients undergoing central venous catheter placement for dialysis, plasmapheresis, or administration of medication and solutions.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Data of 202 adult patients with 219 central venous catheterizations were retrospectively analyzed. Each catheter insertion was followed by an agitated saline bubble-enhanced transthoracic echocardiography, which was used to localize the tip of the catheter. The position of catheter was then controlled by chest radiograph in all cases. During the 13-month study period, two catheter malpositions occurred. Both were identified by agitated saline bubble-enhanced transthoracic echocardiography and confirmed by chest radiograph. The mean time between catheter insertion and chest radiograph control (28.3 min) was clearly longer than agitated saline bubble-enhanced transthoracic echocardiography (3.2 min) (p < 0.001). The total costs of the procedure were reduced by 86.7-95.0%. Specific complications related to the procedure were not observed.

CONCLUSIONS: The results revealed that the accuracy of agitated saline bubble-enhanced transthoracic echocardiography is equivalent to the chest radiograph. It offers a safe, cost-effective, expeditious alternative to routine chest radiograph for position controls of central venous catheters.

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