Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography
Francesco Corradi,
Fabio Guarracino,
Gregorio Santori,
Claudia Brusasco,
Guido Tavazzi,
Gabriele Via,
Silvia Mongodi,
Francesco Mojoli,
Raffaello Umberto Dario Biagini,
Alessandro Isirdi,
Federico Dazzi,
Chiara Robba,
Luigi Vetrugno,
Francesco Forfori,
UCARE research group
Affiliations
Francesco Corradi
Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa
Fabio Guarracino
Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana
Gregorio Santori
Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa
Claudia Brusasco
Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera
Guido Tavazzi
Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia
Gabriele Via
Cardiac Anesthesia and Intensive Care, Fondazione Cardiocentro Ticino
Silvia Mongodi
Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo
Francesco Mojoli
Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia
Raffaello Umberto Dario Biagini
Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa
Alessandro Isirdi
Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa
Federico Dazzi
Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa
Chiara Robba
Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa
Luigi Vetrugno
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara
Francesco Forfori
Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa
Abstract Background To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. Methods A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. Results As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view. Conclusions The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.
