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. We can use the ultrasound to detect position of catheter tip and pneumothorax after insertion of central line as a better alternative to routine portable chest X-ray with higher accuracy. Keywords : Ultrasound, central venous catheter, portable chest X-ray, pneumothorax, catheter position, CT chest. REFERENCES O'Grady NP, Alexander M and Dellinger EP. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 2002; 51:1-18. Irwin RS and Rippe's JM. Procedures and Techniques: in Intensive Care Medicine. 5th ed. Philadelphia, Lippincott Williams and Wilkins Company 2003:17-18. Ng PK, Ault MJ and Maldonado LS. Peripherally inserted central catheters in the intensive care unit. J Intensive Care Med 1996; 11:49-52. Linos DA, Mucha P and Van Heerden JA. Subclavian vein: a golden route. Mayo Clin Proc 1980; 55:315. Merrell SW, Peatross BG and Grossman MD. Peripherally inserted central venous catheters: low-risk alternatives for ongoing venous access. West J Med 1994; 160:259. Lam S, Scannell R and Roessler D. Peripherally inserted central catheters in an acute-care hospital. Arch Intern Med 1994; 154:1833-9. Kondro WA. Alberta retreats over sterilisation compensation. Lancet 1998; 351:892. Hall JB, Shmidt GA and Wood LD. Intravascular Devices: in Principles Of critical Care. 3rd ed. New York, McGraw-Hill Company 2005:131-138. De Lorenzo RA, Morris MJ, Williams JB, et al. Does a simple bedside sonographic measurement of the inferior vena cava correlate to central venous pressure?. J Emerg Med 2012; 42(4):429-36. Dubick MA. Small-volume fluid resuscitation for the far-forward combat environment: current concepts. J Trauma 2003; 54(5 Suppl): s43–5. Porika Raju and Estari Mamidala (2015). Anti-diabetic activity of compound isolated from Physalis angulata fruit extracts in alloxan induced diabetic rats. The Ame J Sci & Med Res, 2015,1(1); Pages 1 -6. doi:10.17812/ajsmr2015.11.1. Lichtenstein D and Mezière G. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE Protocol. Chest 2008; 134:117-25. Magder S. How to use central venous pressure measurements. Current Opinion in Critical Care 2005; 11(3):264-70. Eisen LA, Narasimhan M, Berger JS, et al. Mechanical complications of central venous catheters. J Intensive Care Med. 2006 Jan-Feb; 21(1):40-6. Wolfram Schummer, Claudia Schummer, Norman Rose, et al. Mechanical complications and malpositions of central venous cannulations by experienced operators. Intensive Care Medicine 33(6):1055-9. Alonso-Quintela P, Oulego-Erroz, Rodriguez-Blanco S, et al. Location of the Central Venous Catheter Tip With Bedside Ultrasound in Young Children: Can We Eliminate the Need for Chest Radiography?. Pediatr Crit Care Med. 2015 Nov; 16(9):e340-5. Duran-Gehring PE, Guirgis FW, McKee KC, et al. The bubble study: ultrasound confirmation of central venous catheter placement. Am J Emerg Med. 2015 Mar; 33(3):315-9. Kamalipour, Hamid, Sedigheh Ahmadi, Karmella Kamali, et al. "Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?." Anesthesiology and Pain Med 2016; 6(5):e38834. Uzma Mumtaz, Zainab Zahur, Muhammad Amjad Chaudhry, et al. Bedside ultrasongraphy: a useful tool for traumatic pneumothorax. J Coll Physicians Surg Pak 2016 Jun; 26(6):459-62. S Manimala Rao, et al. “Can we predict the Position of Central Venous Catheter Tip Following Cannulation of Internal Jugular Vein?. EC Anaesthesia 2015; 2(3):126-30.

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