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Published on: December 23, 2014
WINFOCUS worldwide survey on central venous catheter insertion and position confirmation practices (CVC-ICON study)
Francesco Corradi1, Giada Cucciolini2, Guido Tavazzi3,4
1Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Via Paradisa, 2, 56124, Pisa, PI, Italy. francesco.corradi@unipi.it.
Insights
Ultrasound guidance for central venous catheter (CVC) insertion is underutilized globally, with chest-X-ray still common for tip confirmation. Standardized training and protocols are needed to improve patient safety and ultrasound adoption.
Area of Science:
- Critical Care Medicine
- Medical Imaging
- Ultrasound Technology
Background:
- Central venous catheters (CVCs) are vital but carry risks from malposition.
- Ultrasound guidance can improve CVC insertion and tip positioning accuracy.
- Global adoption of ultrasound for CVC procedures varies significantly.
Purpose of the Study:
- To assess worldwide practices in CVC insertion and tip position confirmation.
- To identify barriers to the consistent use of ultrasound in CVC procedures.
Main Methods:
- A global web-based survey was distributed to World Interactive Network Focused On Critical Ultrasound (WINFOCUS) members.
- The survey collected data on clinical experience, CVC insertion techniques, and methods for tip position verification.
- Data from 1,227 respondents across five continents were analyzed.
Main Results:
- Over 70% of experienced physicians use ultrasound guidance for CVC insertion, primarily in the internal jugular vein.
- Ultrasound use is less consistent for guidewire confirmation (44%) and tip position assessment (12% rely solely on bedside ultrasound).
- Chest-X-ray remains the primary method for tip position assessment (52%), with institutional guidelines and medico-legal concerns cited as barriers to exclusive ultrasound use.
Conclusions:
- Despite proven benefits, ultrasound use for CVC insertion and tip confirmation is inconsistent globally.
- Chest-X-ray is still widely employed for tip verification, highlighting a gap in practice.
- Standardized protocols and enhanced training are crucial to increase ultrasound adoption and improve patient safety.
Background:
Central venous catheters (CVC) are essential in medicine for monitoring, drug and fluid administration, and renal replacement therapy. Complications such as arrhythmias, endothelial damage, thrombosis, or hemothorax might arise from incorrect positioning. Despite evidence showing their reduction using ultrasound to guide insertion and correct tip positioning, and greater accuracy for tip position assessment vs. chest-X-ray (CXR), ultrasound adoption greatly varies worldwide. This study, conducted by the World Interactive Network Focused On Critical Ultrasound (WINFOCUS) aimed to assess global practices in CVC insertion and tip position confirmation.
Methods:
A web-based survey was conducted (April-September 2023) among WINFOCUS members/affiliates across five continents. It assessed clinical backgrounds, CVC insertion and tip position check methods, and reasons for not using ultrasound. Developed by WINFOCUS Research sub-committee, the survey was emailed, with two reminders. Data were analyzed using SPSS 27.0.
Results:
A total of 1,227 respondents (5.1% response rate) participated, mainly from Europe (33.5%), Asia (28.3%), and the Americas (30.9%), with 95.4% being physicians. Over half (51.3%) had over six years of experience and placed over 200 CVC, mostly using ultrasound guidance (70% of cases). The internal jugular vein (IJV) was the preferred insertion site (74%). Ultrasound was used for pre-insertion assessment (55%) and vessel puncture (57%) but less for guidewire confirmation (44%). CXR remained the primary method for tip position assessment (52%), while only 12% relied solely on bedside ultrasound. Barriers to exclusive ultrasound use included institutional guidelines (33.9%) and medico-legal concerns (13.8%).
Conclusions:
Despite evidence favoring ultrasound for CVC insertion and tip position confirmation, its use remains inconsistent, with CXR still widely used. This survey underscores the need for standardized protocols and training to enhance US adoption, improve patient safety, and reduce CXR reliance.
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