HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Wirsing, M. Articles by Schummer, W. PubMed PubMed Citation Articles by Wirsing, M. Articles by Schummer, W.

Is Traditional Reading of Bedside Chest Radiograph Appropriate to Detect Intra-atrial Central Venous Catheter Position?

¹Friedrich-Schiller University of Jena, Erlanger Allee 101, 07747 Jena, Germany, Department of Anesthesiology and Intensive Care Medicine ²Friedrich-Schiller University of Jena, Erlanger Allee 101, 07747 Jena, Germany, Institute of Diagnostic and Interventional Radiology

cwsm.schummer{at}gmx.de

Abstract

Background: Traditionally, the positioning outside the right atrium (RA) of central venous catheters (CVC) in intensive care patients is determined by surrogate landmarks on bedside chest-radiographs (CXR). The validity of this method was examined by comparing readings of radiologists with the results of transesophageal echocardiography (TEE).

Methods: Prospective study at university hospital: 213 adults scheduled for cardiothoracic surgery were randomized to right or left internal jugular vein catheterization under ECG-guidance. One senior radiologist (R1) and two radiologists in training (T1, T2) independently read the CXRs. They determined whether the CVC-tip ended in the RA and measured the vertical distance of the CVC-tip from the carina (TC-distance).

Results: 212 CVC-tips could be identified by TEE. Only left-sided CVCs (n=5) ended in the upper RA (2.4%). Three of those patients were smaller than 160 cm. Specificity was 94% for R1, 44% for T1 and 60% for T2. The TC-distance of intra-atrial catheters was 39, 55, 59, 80, 83 mm, respectively. Thus, a TC-distance 55 mm assured extra-atrial tip position in four out of five intra-atrial CVCs (80%, p = 0.002). The TC-distance of extra-atrial catheters ranged from -26 to 102 mm.

Conclusions: Reading of a bedside-CXR alone is not very accurate to identify intra-atrial CVC-tip position. TC-distance is a helpful marker and its specificity is as good as that of an experienced radiologist if a cut-off value of 55 mm is chosen. (231 words)

Ethik Kommission der Friedrich-Schiller-Universität Jena: 1518-03/05

Key Words: MONITORING – electrocardiography • ECHOCARDIOGRAPHY • HEART – catheterization • RADIOLOGY • ANATOMY • jugular vein