Agitated saline bubble-enhanced transthoracic echocardiography: a novel method to visualize the position of central venous catheter

Crit Care Med. 2014 Mar;42(3):e231-3. doi: 10.1097/CCM.0000000000000130.

Abstract

Objectives: The purpose of this study is to describe a novel method to visualize the position of central venous catheters, which is safe, expeditious, and less expensive than the routine postprocedural chest radiograph.

Design: Retrospective comparative study.

Setting: Dialysis Center of the Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

Patients: Two hundred and two adult patients undergoing central venous catheter placement for dialysis, plasmapheresis, or administration of medication and solutions.

Interventions: None.

Measurements and main results: Data of 202 adult patients with 219 central venous catheterizations were retrospectively analyzed. Each catheter insertion was followed by an agitated saline bubble-enhanced transthoracic echocardiography, which was used to localize the tip of the catheter. The position of catheter was then controlled by chest radiograph in all cases. During the 13-month study period, two catheter malpositions occurred. Both were identified by agitated saline bubble-enhanced transthoracic echocardiography and confirmed by chest radiograph. The mean time between catheter insertion and chest radiograph control (28.3 min) was clearly longer than agitated saline bubble-enhanced transthoracic echocardiography (3.2 min) (p < 0.001). The total costs of the procedure were reduced by 86.7-95.0%. Specific complications related to the procedure were not observed.

Conclusions: The results revealed that the accuracy of agitated saline bubble-enhanced transthoracic echocardiography is equivalent to the chest radiograph. It offers a safe, cost-effective, expeditious alternative to routine chest radiograph for position controls of central venous catheters.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / methods*
  • Central Venous Catheters*
  • Cohort Studies
  • Echocardiography / methods*
  • Female
  • Humans
  • Image Enhancement / methods*
  • Jugular Veins / diagnostic imaging*
  • Male
  • Middle Aged
  • Patient Safety
  • Plasmapheresis / instrumentation
  • Plasmapheresis / methods
  • Renal Dialysis / instrumentation
  • Renal Dialysis / methods
  • Retrospective Studies
  • Sodium Chloride

Substances

  • Sodium Chloride