EM - ORIGINAL

Internal and Emergency Medicine

, Volume 8, Issue 2, pp 173-180

Verification of correct central venous catheter placement in the emergency department: comparison between ultrasonography and chest radiography

  • Maurizio ZanobettiAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of FlorenceSOD Osservazione Breve Intensiva, Azienda Ospedaliero-Universitaria Careggi Email author 
  • , Alessandro CoppaAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
  • , Federico BullettiAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
  • , Serena PiazzaAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
  • , Peyman NazerianAffiliated withEmergency Department, Careggi University Hospital
  • , Alberto ContiAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
  • , Francesca InnocentiAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
  • , Stefano PonchiettiAffiliated withEmergency Department, Careggi University Hospital
  • , Sofia BigiariniAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
    • , Aurelia GuzzoAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
    • , Claudio PoggioniAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
    • , Beatrice Del TagliaAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
    • , Yuri MarianniniAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence
    • , Riccardo PiniAffiliated withIntensive Observation Unit, Careggi University HospitalDepartment of Critical Care Medicine and Surgery, University of Florence

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

In 210 consecutive patients undergoing emergency central venous catheterization, we studied whether an ultrasonography examination performed at the bedside by an emergency physician can be an alternative method to chest X-ray study to verify the correct central venous catheter placement, and to identify mechanical complications. A prospective, blinded, observational study was performed, from January 2009 to December 2011, in the emergency department of a university-affiliated teaching hospital. Ultrasonography interpretation was completed during image acquisition; ultrasound scan was performed in 5 ± 3 min, whereas the time interval between chest radiograph request and its final interpretation was 65 ± 74 min p < 0.0001. We found a high concordance between the two diagnostic modalities in the identification of catheter position (Kappa = 82 %, p < 0.0001), and their ability to identify a possible wrong position showed a high correlation (Pearson’s r = 0.76 %, p < 0.0001) with a sensitivity of 94 %, a specificity of 89 % for ultrasonography. Regarding the mechanical complications, three iatrogenic pneumothoraces occurred, all were correctly identified by ultrasonography and confirmed by chest radiography (sensitivity 100 %). Our study showed a high correlation between these two modalities to identify possible malpositioning of a catheter resulting from cannulation of central veins, and its complications. The less time required to perform ultrasonography allows earlier use of the catheter for the administration of acute therapies that can be life-saving for the critically ill patients.

Keywords

Emergency medicine Emergency ultrasonography Chest radiography Central venous catheter