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Guidewire localization by transthoracic echocardiography during central venous catheter insertion: a periprocedural method to evaluate catheter placement

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Abstract

Purpose

To evaluate the feasibility of guidewire detection in right cardiac cavities by transthoracic echocardiography (TTE) in order to detect catheter misplacement and to optimize central venous catheter (CVC) positioning. Ultrasonic control for catheter tip positioning was compared to that by chest X-ray (CXR).

Methods

We conducted a monocentric prospective observational study (January–November 2010). All consecutive patients undergoing CVC insertion were included. The puncture was performed using the landmark method or ultrasound guidance. TTE was performed during the procedure to follow the arrival of the guidewire in the right cardiac cavities. Catheter misplacement was defined as an aberrant position on the postprocedural CXR (catheter positioning in ipsilateral or contralateral veins). The primary endpoint was the prediction of catheter misplacement by guidewire detection in the cardiac cavities. The secondary endpoint was the optimization of the catheter tip placement in the superior vena cava.

Results

A total of 98 patients received 101 CVC. The guidewire was visualized in 92 cases. In five cases, the guidewire was not seen in the right cardiac cavities and CXR showed catheter misplacement. In four cases, poor echogenicity led to the ultrasound examination being abandoned. Catheter misplacement was detected by TTE with a sensitivity of 96 % (CI 90–98 %), a specificity of 83 % (CI 44–97 %), a positive predictive value of 98 %, and a negative predictive value of 55 %. Likelihood ratios were LR+ 5.7 (CI 0.96–34.4) and LR− 0.05 (CI 0.02–0.14). Guidewire removal under TTE avoided an excessively distal position of the catheter tip in all cases.

Conclusion

TTE is a reliable tool to detect catheter misplacement and to optimize catheter tip positioning during the procedure of CVC insertion.

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Acknowledgments

The authors did not benefit any financial support for the study, including any institutional department funds.

Conflicts of interest

None.

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Authors and Affiliations

  1. Département Anesthésie et Réanimation, Unité de Réanimation Polyvalente, Hôpital Purpan, EA 4564 MATN IFR 150, CHU Toulouse, Université Paul Sabatier, Toulouse, France

    Jerome Bedel, Arnaud Mari, Beatrice Riu, Thomas Geeraerts, Michèle Génestal, Vincent Minville & Olivier Fourcade

  2. Réanimation Chirurgicale et le Laboratoire de Recherche du Département d’Anesthésie-Réanimation, EA 322, Université Paris 7 Denis Diderot, 75010, Paris, France

    Fabrice Vallée

  3. Réanimation Médico-Chirurgicale, Centre Hospitalier André Mignot, 78150, Le Chesnay, France

    Benjamin Planquette

Authors
  1. Jerome Bedel
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  2. Fabrice Vallée
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  3. Arnaud Mari
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  4. Beatrice Riu
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  5. Benjamin Planquette
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  6. Thomas Geeraerts
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  7. Michèle Génestal
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  8. Vincent Minville
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  9. Olivier Fourcade
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Corresponding author

Correspondence to Jerome Bedel.

Additional information

The study was conducted in the Intensive Care Unit of Hopital Purpan, Place Dr Baylac, TSA 40031, 31059 Toulouse, Cedex 9, France.

Electronic supplementary material

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134_2013_3097_MOESM1_ESM.tif

Chest X-ray. a Central venous catheter ends in the RA–SVC junction (white arrow). b Catheter loop in the subclavian–jugular junction. White arrows show catheter tip (TIFF 313 kb)

134_2013_3097_MOESM2_ESM.jpg

Measurement of the intravascular length of catheter (IVGL) using the marked catheter as aruler. Calculation of IVGL was performed by substracting the distance measured between the skinand the 2nd (or 3rd) mark on the guidewire, from 20 cm (or 32 cm) which are the position ofthese marks (JPEG 18 kb)

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Bedel, J., Vallée, F., Mari, A. et al. Guidewire localization by transthoracic echocardiography during central venous catheter insertion: a periprocedural method to evaluate catheter placement. Intensive Care Med 39, 1932–1937 (2013). https://doi.org/10.1007/s00134-013-3097-3

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  • DOI: https://doi.org/10.1007/s00134-013-3097-3

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