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Comparison between ultrasonography and X-ray as evaluation methods of central venous catheter positioning and their complications in pediatrics

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Abstract

Purpose

This study evaluates the capacity of ultrasonography as a diagnostic method to confirm the proper positioning of central venous catheter (CVC) when compared to the current gold standard, chest radiography (CR).

Methods

A prospective study was performed including children from 0 to 14 incomplete years, who underwent CVC placement between March and May 2018 at a teaching hospital in Brazil. A four-chamber view of the heart was performed with ultrasound during a rapid injection of saline solution to identify hyperechoic images and confirm the central position of the catheter. After that, a CR was performed. The diagnostic quality of ultrasound was evaluated based on accuracy, sensitivity, specificity, positive and negative predictive values.

Results

A total of 21 patients were analyzed. The mean age was 3.95 ± 4.01 years. The preferred puncture site was the right internal jugular vein (71.4%). Ultrasound accuracy to detect CVC positioning was 81%. Sensitivity, specificity and positive and negative predictive values were 33%, 100%, 100% and 79%, respectively.

Conclusion

Ultrasound is a reliable method for detection of CVC positioning. Even so, with the four-chamber cardiac view, this method is unable to identify catheters inside heart chambers, therefore, needing to confirm the positioning with CR.

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References

  1. Ruesch S, Walder B, Tramèr MR (2002) Complications of central venous catheters: internal jugular versus subclavian access–a systematic review. Crit Care Med 30:454–460

    Article  Google Scholar 

  2. McGee DC, Gould MK (2003) Preventing complications of central venous catheterization. N Engl J Med 348:1123–1133. https://doi.org/10.1056/NEJMra011883

    Article  PubMed  Google Scholar 

  3. Randolph AG, Cook DJ, Gonzales CA, Pribble CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 24:2053–2058

    Article  CAS  Google Scholar 

  4. Benter T, Teichgräber UK, Klühs L, Papadopoulos S, Köhne CH, Felix R et al (2001) Anatomical variations in the internal jugular veins of cancer patients affecting central venous access. Ultraschall Der Medizin 22:23–26. https://doi.org/10.1055/s-2001-11243

    Article  CAS  Google Scholar 

  5. Nayeemuddin M, Pherwani AD, Asquith JR (2013) Imaging and management of complications of central venous catheters. Clin Radiol 68:529–544. https://doi.org/10.1016/j.crad.2012.10.013

    Article  CAS  PubMed  Google Scholar 

  6. Pittiruti M, Lamperti M (2015) Late cardiac tamponade in adults secondary to tip position in the right atrium: an urban legend? a systematic review of the literature. J Cardiothorac Vasc Anesth 29:491–495. https://doi.org/10.1053/j.jvca.2014.05.020

    Article  PubMed  Google Scholar 

  7. Molgaard O, Nielsen MS, Handberg BB, Jensen JM, Kjaergaard J, Juul N (2004) Routine X-ray control of upper central venous lines: Is it necessary? Acta Anaesthesiol Scand 48:685–689. https://doi.org/10.1111/j.0001-5172.2004.00400.x

    Article  CAS  PubMed  Google Scholar 

  8. Maury E, Guglielminotti J, Alzieu M, Guidet B, Offenstadt G (2001) Ultrasonic examination. Am J Respir Crit Care Med 164:403–405. https://doi.org/10.1164/ajrccm.164.3.2009042

    Article  CAS  PubMed  Google Scholar 

  9. Vesely TM (2003) Central venous catheter tip position: A continuing controversy. J Vasc Interv Radiol 14:527–534. https://doi.org/10.1097/01.RVI.0000071097.76348.72

    Article  PubMed  Google Scholar 

  10. Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG (2007) Mechanical complications and malpositions of central venous cannulations by experienced operators: a prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med 33:1055–1059. https://doi.org/10.1007/s00134-007-0560-z

    Article  PubMed  Google Scholar 

  11. Baumgarten RK (2007) The real ultrasound revolution [1]. Anesth Analg 104:1292. https://doi.org/10.1213/01.ane.0000263240.89121.D0

    Article  PubMed  Google Scholar 

  12. Ablordeppey EA, Drewry AM, Beyer AB, Theodoro DL, Fowler SA, Fuller BM et al (2017) Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically Ill patients: a systematic review and meta-analysis. Crit Care Med 45:715–724. https://doi.org/10.1097/CCM.0000000000002188

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. L. Oliveira, L. Pilz contributed equally to the paper.

Authors and Affiliations

  1. Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil

    L. Oliveira, C. M. Tognolo, C. Bischoff, K. A. Becker, G. G. Oliveira, C. G. Fachin, M. A. Agulham & A. I. B. S. Dias

  2. Medical Student, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil

    L. Pilz & P. J. F. Neves

Authors
  1. L. Oliveira
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  2. L. Pilz
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  3. C. M. Tognolo
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  4. C. Bischoff
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  5. K. A. Becker
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  6. G. G. Oliveira
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  7. P. J. F. Neves
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  8. C. G. Fachin
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  9. M. A. Agulham
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  10. A. I. B. S. Dias
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Corresponding author

Correspondence to L. Oliveira.

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The authors declare that they have no conflict of interest.

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It was obtained from all individual participants included in the study.

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Oliveira, L., Pilz, L., Tognolo, C.M. et al. Comparison between ultrasonography and X-ray as evaluation methods of central venous catheter positioning and their complications in pediatrics. Pediatr Surg Int 36, 563–568 (2020). https://doi.org/10.1007/s00383-020-04642-y

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  • DOI: https://doi.org/10.1007/s00383-020-04642-y

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