Validity of ultrasonography in detection of central venous catheter position and pneumothorax compared with portable chest radiography

Abstract

Background Ultrasonographic guidance for insertion of central venous catheters (CVC) is now almost a standard of care, leading to fewer failed attempts and complications. We evaluated the use of ultrasound examination to detect the position of the CVC and pneumothorax (PTX) occurrence after CVC insertion as an alternative to chest radiography (CXR). Patients and methods This study was carried out on 100 catheter insertions for patients who were admitted to Critical Care Department in Alexandria Main University Hospital. Confirmation of endovenous placement of the catheter was done by ultrasonography using ‘Bubble test’ along with the examination of internal jugular veins and subclavian veins of both sides. Then, lung ultrasound was used to detect PTX occurrence. After that, a portable CXR and computed tomography (CT) of the chest were done for all patients. Results In detection of the catheter position, the ultrasound showed sensitivity and specificity of 82.7 and 96.8%, respectively, versus 93.8 and 95.8%, respectively, for portable radiography. Furthermore, in detection of postinsertion PTX, the ultrasound showed sensitivity and specificity of 90 and 96.3%, respectively, versus 45 and 96.3%, respectively, for portable CXR. Conclusion Ultrasound may be used to detect the position of catheter tip and PTX as a better alternative to routine portable CXR with higher accuracy.