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.

Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography

Francesco Corradi
Primo
Writing – Original Draft Preparation
;
Fabio Guarracino;Raffaello Umberto Dario Biagini;Alessandro Isirdi;Federico Dazzi;Luigi Vetrugno;Francesco Forfori;Maria Lidia Bologna;Alessandro Cardu;Laura Crocetti;Francesco Cundari;Elisa Del Frate;Samuele Ferrari;Alberto Laffi;Elena Marrucci;Marco Monfroni;Chiara Piagnani;Erika Taddei;Ludovica Tecchi;Sara Tempini;Debora Tognarelli;
2022-01-01

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.
2022
Corradi, Francesco; Guarracino, Fabio; Santori, Gregorio; Brusasco, Claudia; Tavazzi, Guido; Via, Gabriele; Mongodi, Silvia; Mojoli, Francesco; Biagini, RAFFAELLO UMBERTO DARIO; Isirdi, Alessandro; Dazzi, Federico; Robba, Chiara; Vetrugno, Luigi; Forfori, Francesco; Bologna, MARIA LIDIA; Cardu, Alessandro; Crocetti, Laura; Cundari, Francesco; DEL FRATE, Elisa; Ferrari, Samuele; Laffi, Alberto; Marrucci, Elena; Monfroni, Marco; Piagnani, Chiara; Taddei, Erika; Tecchi, Ludovica; Tempini, Sara; Tognarelli, Debora; Vullo, Carmelo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1157400
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