SESSION TYPE: Invasive Procedures and Hemodynamic Monitoring Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: The use of ultrasound (USG) guidance for Central Venous Catheters (CVC) placement is now standard, and recent evidence suggests that routine post procedural Chest X Rays (CXR) may not be needed after uncomplicated insertion of CVC through the internal jugular ( IJ) vein. We hypothesized that USG confirmation of appropriate guidewire (GW) position and presence of sliding lung sign would eliminate the requirement for routine CXR.
METHODS: We conducted a retrospective chart review of all (n=30) USG guided IJ CVC catheterizations performed over a 6 month period by our intensivists. Two-tailed Fisher’s exact test was used for comparisons between the groups that used (n=23) or did not use (n=7) USG confirmation of GW placement. All patients had CXRs, interpreted by a radiologist.
RESULTS: Confirmation of correct GW position in the IJ vein and presence of sliding lung sign was reported in 23 and 5 of the 30 procedures performed, respectively. There were no pneumothoraces or arterial canulations. In 6 instances, CVC were malpositioned as judged by CXR. In the group with GW confirmation, 2/23 CVC were malpositioned (1 coiled, 1 shallow), and in the group without USG confirmation of GW position 4/7 CVC were malpositioned (1 shallow, 1 peripheral, 2 deep).
CONCLUSIONS: Although confirmation of correct GW positioning by USG was associated with significantly lower incidence of CVC malposition (p =0.0157), it did not eliminate the requirement of CXR to detect CVC malposition. With USG guided CVC placement, the risk of pneumothorax is so small that routine assessment for sliding lung is unnecessary.
CLINICAL IMPLICATIONS: After USG-guided CVC placement, routine CXR is still useful to detect catheter malpositioning.
DISCLOSURE: The following authors have nothing to disclose: Taro Minami, Asha Shrestha, Jigme Sethi
No Product/Research Disclosure InformationMemorial Hospital of Rhode Island, Pawtucket, RI