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The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
Published on: December 23, 2014
Catheter detection by transthoracic echocardiography during placement of peripherally inserted central catheters: a
Yong Chae Jung1, Man-Shik Shim1, Hee Sun Park2
1Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
Insights
Transthoracic echocardiography (TTE) reliably detects peripherally inserted central catheter (PICC) misplacement during placement. This method improves accuracy and optimizes catheter tip positioning, enhancing patient safety in central venous access procedures.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Access
Background:
- Current central venous access guidelines lack specificity for peripherally inserted central catheters (PICCs).
- Existing methods for PICC placement monitoring have limitations in sensitivity and specificity.
- Transthoracic echocardiography (TTE) offers a potential solution for real-time catheter visualization.
Purpose of the Study:
- To evaluate the feasibility of using TTE for detecting catheter tip position in the right atrial cavity during PICC placement.
- To assess TTE's accuracy in identifying misplaced PICCs.
- To explore TTE's role in optimizing PICC tip positioning and reducing complications.
Main Methods:
- A single-center, retrospective study of 100 patients undergoing PICC placement with concurrent TTE.
- TTE was used to visualize catheter arrival in the right atrial cavity.
- Catheter misplacement was confirmed by chest x-ray (CXR), and TTE's diagnostic performance was calculated.
Main Results:
- TTE visualized the catheter in the right atrial cavity in 90 out of 100 patients.
- Catheter misplacement was identified in 7% of cases via CXR.
- TTE demonstrated high sensitivity (97%) and specificity (90%) for detecting PICC misplacement.
Conclusions:
- Transthoracic echocardiography is a dependable tool for real-time detection of PICC misplacement.
- TTE aids in optimizing catheter tip positioning during PICC insertion.
- This technique enhances the safety and efficacy of central venous catheterization.
Background:
Although guidelines and protocols are available for central venous access, existing methods lack specificity and sensitivity, especially when placing peripherally inserted central catheters (PICCs). We evaluated the feasibility of catheter detection in the right atrial cavity using transthoracic echocardiography (TTE) during PICC placement.
Methods:
This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications.
Results:
Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%-99.36%), 90% CI (55.50%-99.75%), 99%, and 75%, respectively.
Conclusions:
TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.
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