• Logo
  • SBMUJournals

Saline Flush versus Chest x ray in Confirmation of Central Venous Catheter Placement; a Diagnostic Accuracy Study

Mehrdad Esmailian, Reza Azizkhani, Nazila Najafi
PDF

Abstract

Introduction: Central venous catheterization (CVC) is a commonly performed procedure in critically ill patients of emergency department. This study was designed to compare the diagnostic accuracy of saline flush with CXR in confirmation of above-the-diaphragm CVC placement. Methods: This prospective cross sectional study was conducted on adult patients in need of CVC placement in emergency department. Placement Confirmation was performed with saline flush method and CXR, then chest computed tomography (CT) was performed as the gold standard. The screening performance characteristics of the two methods were calculated and compared using SPSS 21 and STATA 11. Results: 103 cases with the mean age of 57.18±9.3 (35 -80) years were studied (52.4% male). The mean duration of procedure was 2.5±1.24 in saline flush and 32.11±5.52 minutes in CXR method (P<0.001(. The area under the ROC curves for saline flush and CXR in confirmation of CVC placement were 0.90 (95%CI: 0.70 – 0.100) and 0.80 (95%CI: 0.55 – 0.100), respectively (p = 0.317). The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of  saline flush were 80%, 100%, 100, 98.9%, Infinity, and 0.01, respectively. These measures were 60%, 100%, 100%, 98%, Infinity, and 0.02 for CXR, respectively. Conclusion: It seems that saline flush method could be considered as a safe, rapid, and accurate bedside method for CVC placement confirmation in emergency department.


Keywords

Catheterization, central venous; sensitivity and specificity; ultrasonography, interventional; diagnostic imaging; chest x ray

References

Schummer W, Schummer C, Rose N, Niesen W-D, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. Intensive care medicine. 2007;33(6):1055-9.

Walshe C, Phelan D, Bourke J, Buggy D. Vascular erosion by central venous catheters used for total parenteral nutrition. Intensive care medicine. 2007;33(3):534-7.

Boardman P, Hughes J. Pictorial review: Radiological evaluation and management of malfunctioning central venous catheters. Clinical radiology. 1998;53(1):10-6.

Starr DS, Cornicelli S. EKG guided placement of subclavian CVP catheters using J-wire. Annals of surgery. 1986;204(6):673.

Ambesh SP, Pandey JC, Dubey PK. Internal jugular vein occlusion test for rapid diagnosis of misplaced subclavian vein catheter into the internal jugular vein. The Journal of the American Society of Anesthesiologists. 2001;95(6):1377-9.

Bowdle A. Vascular complications of central venous catheter placement: evidence-based methods for prevention and treatment. Journal of cardiothoracic and vascular anesthesia. 2014;28(2):358-68.

Costello JM, Clapper TC, Wypij D. Minimizing complications associated with percutaneous central venous catheter placement in children: recent advances. Pediatric Critical Care Medicine. 2013;14(3):273-83.

Maury E, Guglielminotti J, Alzieu M, Guidet B, Offenstadt G. Ultrasonic examination: an alternative to chest radiography after central venous catheter insertion? American journal of respiratory and critical care medicine. 2001;164(3):403-5.

Vezzani A, Brusasco C, Palermo S, Launo C, Mergoni M, Corradi F. Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography. Critical care medicine. 2010;38(2):533-8.

Toshniwal GR, Rath GP, Bithal PK. Flush Test—A New Technique to Assess the Malposition of Subclavian Central Venous Catheter Position in the Internal Jugular Vein. Journal of neurosurgical anesthesiology. 2006;18(4):268-9.

Rath G, Bithal P, Toshniwal G, Prabhakar H, Dash H. Saline flush test for bedside detection of misplaced subclavian vein catheter into ipsilateral internal jugular vein. British journal of anaesthesia. 2009;102(4):499-502.

Weekes AJ, Johnson DA, Keller SM, Efune B, Carey C, Rozario NL, et al. Central vascular catheter placement evaluation using saline flush and bedside echocardiography. Academic Emergency Medicine. 2014;21(1):65-72.

Gekle R, Dubensky L, Haddad S, Catlin T, Stickles S, D'amore J, et al. Can Bedside Sonography Replace Conventional Radiography for Confirmation of Above-the-Diaphragm Central Venous Catheter Placement? Annals of Emergency Medicine. 2013;62(4):S34-S5.

Duran-Gehring PE, Guirgis FW, McKee KC, Goggans S, Tran H, Kalynych CJ, et al. The bubble study: ultrasound confirmation of central venous catheter placement. The American journal of emergency medicine. 2015;33(3):315-9.

Matsushima K, Frankel HL. Detection of central venous catheter insertion-related complication using bedside ultrasound: the CVC sono. Journal of Trauma and Acute Care Surgery. 2011;70(6):1561-3.

Puls LE, Twedt CA, Hunter JE, Langan EM, Crane M. Confirmatory chest radiographs after central line placement: are they warranted? Southern medical journal. 2003;96(11):1138-42.

Sanabria A, Henao C, Bonilla R, Castrillón C, Cruz H, Ramírez W, et al. Routine chest roentgenogram after central venous catheter insertion is not always necessary. The American journal of surgery. 2003;186(1):35-9.

Lessnau K-D. Is chest radiography necessary after uncomplicated insertion of a triple-lumen catheter in the right internal jugular vein, using the anterior approach? Chest. 2005;127(1):220-3.




DOI: http://dx.doi.org/10.22037/emergency.v5i1.18116

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.