Comparison between ultrasound and chest X-ray to confirm central venous catheter tip position

SA Journal of Radiology

Field Value
Title Comparison between ultrasound and chest X-ray to confirm central venous catheter tip position
Creator de Man, Leoni Wentzel, Mari van Rooyen, Cornel Turton, Edwin
Subject — central venous catheter; position; chest X-ray; ultrasound; peri-operative; CVC; CXR
Description Background: Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray (CXR) is usually performed postoperatively.Objectives: This prospective observational study assessed the diagnostic accuracy of peri-operative ultrasound and a ‘bubble test’ to detect malposition and pneumothorax.Method: Sixty-one patients undergoing peri-operative CVC placement were included. An ultrasound protocol was used to directly visualise the CVC, perform the ‘bubble test’ and assess for the presence of pneumothorax. The time from agitated saline injection to visualisation of microbubbles in the right atrium was evaluated to determine the correct position of the CVC. The time required to perform the ultrasound assessment was compared to that of conducting the CXR.Results: Chest X-ray identified 12 (19.7%) malpositions while ultrasound identified 8 (13.1%). Ultrasound showed a sensitivity of 0.85 (95% confidence interval [CI]: 0.72 to 0.93) and a specificity of 0.5 (95% CI: 0.16 to 0.84). The positive and negative predictive values were 0.92 (95% CI: 0.80 to 0.98) and 0.33 (95% CI: 0.10 to 0.65), respectively. No pneumothorax was identified on ultrasound and CXR. The median time for ultrasound assessment was significantly shorter at 4 min (interquartile range [IQR]: 3–6 min), compared to performing a CXR that required a median time of 29 min (IQR: 18–56 min) (p  0.0001).Conclusion: This study showed that ultrasound produced a high sensitivity and moderate specificity in detecting CVC malposition.Contribution: Ultrasound can improve efficiency when used as a rapid bedside screening test to detect CVC malposition.
Publisher AOSIS
Date 2023-06-29
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — —
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajr.v27i1.2587
Source South African Journal of Radiology; Vol 27, No 1 (2023); 8 pages 2078-6778 1027-202X
Language eng
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Rights Copyright (c) 2023 Leoni de Man, Mari Wentzel, Cornel van Rooyen, Edwin Turton