Bedside ultrasound reliability in locating catheter and detecting complications

Abstract

Introduction: Central venous catheterization is one of the most common medical procedures and is associated with such complications as misplacement and pneumothorax. Chest X-ray is among good ways for evaluation of these complications. However, due to patient’s excessive exposure to radiation, time consumption and low diagnostic value in detecting pneumothorax in the supine patient, the present study intends to examine bedside ultrasound diagnostic value in locating tip of the catheter and pneumothorax. Materials and methods: In the present cross-sectional study, all referred patients requiring central venous catheterization were examined. Central venous catheterization was performed by a trained emergency medicine specialist, and the location of catheter and the presence of pneumothorax were examined and compared using two modalities of ultrasound and x-ray (as the reference standard). Sensitivity, specificity, and positive and negative predicting values were reported. Results: A total of 200 non-trauma patients were included in the study (58% men). Cohen’s Kappa consistency coefficients for catheterization and diagnosis of pneumothorax were found as 0.49 (95% CI: 0.43-0.55), 0.89 (P<0.001), (95% CI: 97.8-100), respectively. Also, ultrasound sensitivity and specificity in diagnosing pneumothorax were 75% (95% CI: 35.6-95.5), and 100% (95% CI: 97.6-100), respectively. Conclusion: The present study results showed low diagnostic value of ultrasound in determining catheter location and in detecting pneumothorax. With knowledge of previous studies, the search still on this field.

Keywords: Central venous catheterization; complications; bedside ultrasound; radiography;