Validity of ultrasonography in detection of central venous catheter position and pneumothorax compared to portable chest X-ray

ABSTRACT Ultrasonographic guidance for insertion of central venous catheter is now almost a standard of care, leading to fewer failed attempts and complications. Nowadays, the ultrasound examination used to detect position of the central line and pneumothorax occurrence as an alternative to X-ray. The aim of this work is to assess validity of ultrasonography and portable chest X-ray in detection of central venous catheter position and post-central line insertion pneumothorax. The study was carried out on one hundred catheter insertions for patients who were admitted to Critical Care Medicine Department in Alexandria Main University Hospital. Confirmation of endovenous placement of the catheter was done by ultrasonography using “Bubble test” and examination of internal jugular veins and subclavian veins of both sides. Then, lung ultrasound was done to detect pneumothorax occurrence. After that, a portable chest X-ray film was done for all patients to detect the catheter tip position and presence of pneumothorax. Then, Computed tomography of the chest was done for all patients after their hemodynamics stabilization to confirm the previous data and compare accuracy of the ultrasound and X-ray to detect catheter tip position and post-insertion pneumothorax. The researcher found that there is statistically significant correlation between site of insertion and incidence of post-insertion pneumothorax occurrence (80% with subclavian approach versus 20% for internal jugular approach). In detection of the catheter position, the ultrasound showed sensitivity and specificity of 82.7%, 96.8% respectively versus 93.8%, 95.8% respectively for portable X-ray. Furthermore, in detection of post-insertion pneumothorax, the ultrasound showed sensitivity and specificity of 90%, 96.3% respectively versus 45%, 96.3% respectively for portable chest X-ray. 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