SESSION TITLE: Outcomes/Quality Control
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 08:45 AM - 10:00 AM
PURPOSE: To evaluate the safety and utility of ultrasonography as a tool to confirm central venous catheter (CVC) position and to exclude insertion related pneumothorax in place of chest radiography (CXR) in a tertiary medical ICU.
METHODS: We randomized 60 consecutive medical ICU patients to conventional or ultrasound groups for CVC placement. Both groups had CVCs inserted under ultrasound guidance. The intervention group underwent real time transthoracic echocardiography to assist in catheter positioning and chest ultrasonography for exclusion of pneumothorax. Our primary endpoint was reduction in CXR use. The secondary endpoint was time elapsed from the end of procedure to the availability of CVC for use. Chi-square test was used to compare the two groups for the primary endpoint. T-test was used to compare the two groups for the secondary end point.
RESULTS: 30 patients were randomized to the conventional group and 30 were randomized to the ultrasound group. 1 patient was excluded in the control group since the procedure needed to be aborted. Patient characteristics were well matched for age, BMI and APACHE III scores. There was a 56.7% (p <0.0001) reduction in CXR use in the ultrasound arm. Mean time to use was 53.6 minutes in the control group and 25 minutes in the ultrasound arm (p = 0.0015). Mean time required to complete the procedure in the control group was 27.7 minutes and 24.1 minutes in the ultrasound group (p value 0.2053). No pneumothoraces were detected in either arm.
CONCLUSIONS: Ultrasound guided CVC placement and positioning reduced the use of bedside CXR and reduced the time to use of the CVC.
CLINICAL IMPLICATIONS: Obtaining a chest x-ray for confirmation of line placement and exclusion of pneumothorax remains the standard of care in most ICUs. Using a minor modification in insertion technique, transthoracic ultrasound reduces the need for CXR to check CVC position without adding significant procedure time and reducing the time delay to approval of line for use compared with radiography.
DISCLOSURE: The following authors have nothing to disclose: Dileep Raman, Manish Sharma, Xiaofeng Wang, Ajit Moghekar, Umur Hatipoglu
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