Abstract
IntroductionChest radiography (CXR) is commonly used to confirm the proper placement of above-diaphragm central venous catheters (CVCs) and to detect associated complications. Recent studies have shown that point-of-care ultrasound (POCUS) has better sensitivity and is faster than CXR for these purposes. We were interested in documenting how often emergency medicine and critical care practitioners perform POCUS to confirm proper CVC positioning as well as their confidence in performing it. MethodsWe surveyed members of our state's chapters of the College of Emergency Physicians and the Society of Critical Care Medicine between April and December 2018. Our primary outcome was the percentage of providers who would agree to perform only POCUS, forgoing CXR, for confirmation of CVC position. We performed multivariable logistic regressions to measure associations between demographic, clinical information, and outcomes. ResultsOne hundred thirty-six providers participated (a 25% participation rate). Their specialties were as follows: emergency medicine, 75%; critical care, 13%; and emergency medicine/critical care, 11%. Thirty-one percent would use POCUS only for CVC confirmation, while 42% were confident in performing POCUS for this purpose. Multivariable logistic regressions showed that performing more non-procedural ultrasound examinations was associated with a higher likelihood of agreeing to perform POCUS only (OR, 2.9; 95% CI: 1.3–6.3). Forty-six percent of relevant comments suggested more training to increase the use of POCUS. ConclusionParticipants in this study did not frequently use POCUS for CVC confirmation. Designers of training curricula should consider including more instruction in the use of POCUS to confirm proper CVC placement and to detect complications.
Highlights
Chest radiography (CXR) is commonly used to confirm the proper placement of above-diaphragm central venous catheters (CVCs) and to detect associated complications
Emergency medicine was the specialty of 103 (76%) participants, while emergency medicine & critical care, and critical care were reported as the specialty of 15 (11%) and 18 (13%) participants, respectively (Table 1)
Up to 96% of participants in our study reported using pointof-care ultrasound (POCUS) for insertion of internal jugular CVC and 24% for subclavian vein CVC
Summary
Chest radiography (CXR) is commonly used to confirm the proper placement of above-diaphragm central venous catheters (CVCs) and to detect associated complications. Insertion of central venous catheters (CVCs), which allow delivery of medication and nutrients not otherwise given safely via peripheral venous catheters, is a common procedure for critically ill patients in emergency departments (EDs) and intensive care units (ICUs) [1]. These catheters carry a risk of mechanical complications and infections, hampering 5%–19% of cases [2, 3, 4]. Different techniques were used to confirm CVC's tip position, including right atrial electrocardiography [5, 6], electrocardiogram guidance [7] and point of care ultrasound (POCUS)
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