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

Autor: Cortellaro F; Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy. Electronic address: francesca.cortellaro@gmail.com., Mellace L; Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy., Paglia S; Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy., Costantino G; Unità Operativa di Medicina a indirizzo fisiopatologico, Dipartimento di Medicina Interna, Ospedale Sacco, Milano, Italy., Sher S; Unità Operativa di Anestesia e Rianimazione, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy., Coen D; Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2014 Jan; Vol. 32 (1), pp. 78-81. Date of Electronic Publication: 2013 Oct 09.
DOI: 10.1016/j.ajem.2013.10.001
Abstrakt: 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.
(© 2013.)
Databáze: MEDLINE
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