Background After catheterization of the central vein, chest X-ray (CXR) is routinely required to determine the position of catheter tip. However, this method is time-consuming and radioactive. Therefore, this study tries to use bedside ultrasound to quickly determine the position of catheter tip.
Objective To evaluate the effectiveness of using echocardiography with microbubble contrast agent to determine the position of central venous catheter (CVC).
Methods Prospective inclusion of critically ill patients who underwent central venous catheterization in the Department of Intensive Care Medicine (ICU) of Peking University People’s Hospital from July 2020 to June 2021 was performed. Oscillating microbubble saline perfusion contrast-enhanced echocardiography technique was applied to determine the position of the central venous catheter tip. Then the patient's general information, contrast echocardiography related indicators and chest X-ray related indicators were collected, and the results of tube placement and examination time with the bedside CXR were compared.
Results A total of 74 patients were enrolled in this study, including 33 males and 41 females with an average age of (67.3 ± 19.3) years. It took only 7.2 minutes (95% CI: 6.6-7.9) to judge the position of central venous catheter by bedside cardiac contrast echocardiography, and 77.8 minutes (95% CI: 69.0-86.6) by chest radiograph, and the difference was significant (P<0.05). Compared to the chest radiograph, the sensitivity of bedside cardiac contrast echocardiography was 100%, specificity 85.7%, and accuracy 98.65%. There was no significant difference for confirming the central venous catheter position between the two diagnostic methods (Kappa=0.916).
Conclusion Compared with CXR, the echocardiography with microbubble contrast agent can be used to determine the position of CVC with accuracy, and it saves time for further clinical treatment.
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