Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Review

Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis

Authors: Jasper M. Smit, Reinder Raadsen, Michiel J. Blans, Manfred Petjak, Peter M. Van de Ven, Pieter R. Tuinman

Published in: Critical Care | Issue 1/2018

Login to get access

Abstract

Background

Insertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US).

Methods

This is a systematic review and meta-analysis registered at PROSPERO (CRD42016050698). PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Articles which reported the diagnostic accuracy of US in detecting the position of CVCs and the mechanical complications associated with insertion were included. Primary outcomes were specificity and sensitivity of US. Secondary outcomes included prevalence of malposition and pneumothorax, feasibility of US examination, and time to perform and interpret both US and chest x-ray. A qualitative assessment was performed using the QUADAS-2 tool.

Results

We included 25 studies with a total of 2548 patients and 2602 CVC placements. Analysis yielded a pooled specificity of 98.9 (95% confidence interval (CI): 97.8–99.5) and sensitivity of 68.2 (95% CI: 54.4–79.4). US examination was feasible in 96.8% of the cases. The prevalence of CVC malposition and pneumothorax was 6.8% and 1.1%, respectively. The mean time for US performance was 2.83 min (95% CI: 2.77–2.89 min) min, while chest x-ray performance took 34.7 min (95% CI: 32.6–36.7 min). US was feasible in 97%. Further analyses were performed by defining subgroups based on the different utilized US protocols and on intra-atrial and extra-atrial misplacement. Vascular US combined with transthoracic echocardiography was most accurate.

Conclusions

US is an accurate and feasible diagnostic modality to detect CVC malposition and iatrogenic pneumothorax. Advantages of US over chest x-ray are that it can be performed faster and does not subject patients to radiation. Vascular US combined with transthoracic echocardiography is advised. However, the results need to be interpreted with caution since included studies were often underpowered and had methodological limitations. A large multicenter study investigating optimal US protocol, among other things, is needed.
Appendix
Available only for authorised users
Literature
1.
2.
McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123–33.CrossRefPubMed
3.
Parienti JJ, Mongardon N, Megarbane B, Mira JP, Kalfon P, Gros A, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373(13):1220–9.CrossRefPubMed
4.
5.
Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of central venous catheters. Clin Radiol. 2013;68(5):529–44.CrossRefPubMed
6.
Hourmozdi JJ, Markin A, Johnson B, Fleming PR, Miller JB. Routine chest radiography is not necessary after ultrasound-guided right internal jugular vein catheterization. Crit Care Med. 2016;44(9):e804–8.CrossRefPubMed
7.
Lichtenstein D, van Hooland S, Elbers P, Malbrain ML. Ten good reasons to practice ultrasound in critical care. Anaesthesiol Intensive Ther. 2014;46(5):323–35.CrossRefPubMed
8.
Vezzani A, Manca T, Vercelli A, Braghieri A, Magnacavallo A. Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications. J Ultrasound. 2013;16(4):161–70.CrossRefPubMedPubMedCentral
9.
Lalu MM, Fayad A, Ahmed O, Bryson GL, Fergusson DA, Barron CC, et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med. 2015;43(7):1498–507.CrossRefPubMed
10.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med. 2009;3(3):e123–30.PubMedPubMedCentral
11.
Millington SJ, Hewak M, Arntfield RT, Beaulieu Y, Hibbert B, Koenig S, et al. Outcomes from extensive training in critical care echocardiography: identifying the optimal number of practice studies required to achieve competency. J Crit Care. 2017;40:99–102.CrossRefPubMed
12.
Ebrahimi A, Yousefifard M, Mohammad Kazemi H, Rasouli HR, Asady H, Moghadas Jafari A, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13(4):29–40.PubMedPubMedCentral
13.
Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013;17(5):R208.CrossRefPubMedPubMedCentral
14.
Abood GJ, Davis KA, Esposito TJ, Luchette FA, Gamelli RL. Comparison of routine chest radiograph versus clinician judgment to determine adequate central line placement in critically ill patients. J Trauma. 2007;63(1):50–6.CrossRefPubMed
15.
Chan TY, England A, Meredith SM, McWilliams RG. Radiologist variability in assessing the position of the cavoatrial junction on chest radiographs. Br J Radiol. 2016;89(1065):20150965.CrossRefPubMedPubMedCentral
16.
Wirsing M, Schummer C, Neumann R, Steenbeck J, Schmidt P, Schummer W. Is traditional reading of the bedside chest radiograph appropriate to detect intraatrial central venous catheter position? Chest. 2008;134(3):527–33.CrossRefPubMed
17.
Salimi F, Hekmatnia A, Shahabi J, Keshavarzian A, Maracy MR, Jazi AH. Evaluation of routine postoperative chest roentgenogram for determination of the correct position of permanent central venous catheters tip. J Res Med Sci. 2015;20(1):89–92.PubMedPubMedCentral
18.
Blans MJ, Endeman H, Bosch FH. The use of ultrasound during and after central venous catheter insertion versus conventional chest x-ray after insertion of a central venous catheter. Neth J Med. 2016;74(8):353–7.PubMed
19.
Matsushima K, Frankel HL. Bedside ultrasound can safely eliminate the need for chest radiographs after central venous catheter placement: CVC sono in the surgical ICU (SICU). J Surg Res. 2010;163(1):155–61.CrossRefPubMed
20.
Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. J Intensive Care Med. 2006;21(1):40–6.CrossRefPubMed
21.
Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med. 2007;33(6):1055–9.CrossRefPubMed
22.
Walker E, Hernandez AV, Kattan MW. Meta-analysis: its strengths and limitations. Cleve Clin J Med. 2008;75(6):431–9.CrossRefPubMed
23.
Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol. 2003;14(5):527–34.CrossRefPubMed
24.
Bedel J, Vallee F, Mari A, Riu B, Planquette B, Geeraerts T, et al. Guidewire localization by transthoracic echocardiography during central venous catheter insertion: a periprocedural method to evaluate catheter placement. Intensive Care Med. 2013;39(11):1932–7.CrossRefPubMed
25.
Kim SC, Graff I, Sommer A, Hoeft A, Weber S. Ultrasound-guided supraclavicular central venous catheter tip positioning via the right subclavian vein using a microconvex probe. J Vasc Access. 2016;17(5):435–9.CrossRefPubMed
26.
Kim SC, Heinze I, Schmiedel A, Baumgarten G, Knuefermann P, Hoeft A, et al. Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe: an observational pilot study. Eur J Anaesthesiol. 2015;32(1):29–36.CrossRefPubMed
27.
Arellano R, Nurmohamed A, Rumman A, Day AG, Milne B, Phelan R, et al. The utility of transthoracic echocardiography to confirm central line placement: an observational study. Can J Anaesth. 2014;61(4):340–6.CrossRefPubMed
28.
29.
Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006;19(12):1413–30.
30.
Khouzam RN, Minderman D, D’Cruz IA. Echocardiography of the superior vena cava. Clin Cardiol. 2005;28(8):362–6.CrossRefPubMed
31.
Vezzani A, Brusasco C, Palermo S, Launo C, Mergoni M, Corradi F. Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography. Crit Care Med. 2010;38(2):533–8.CrossRefPubMed
32.
Meggiolaro M, Scatto A, Zorzi A, Roman-Pognuz E, Lauro A, Passarella C, et al. Confirmation of correct central venous catheter position in the preoperative setting by echocardiographic “bubble-test”. Minerva Anestesiol. 2015;81(9):989–1000.PubMed
33.
Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21(1):225.CrossRefPubMedPubMedCentral
34.
Steenvoorden TS, Smit JM, Haaksma ME, Tuinman PR. Necessary additional steps in ultrasound guided central venous catheter placement: getting to the heart of the matter. Crit Care. 2017;21(1):307.CrossRefPubMedPubMedCentral
35.
Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. J Am Coll Cardiol. 2011;57(9):1126–66.CrossRefPubMed
36.
Lichtenstein D, Meziere G, Biderman P, Gepner A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26(10):1434–40.CrossRefPubMed
37.
Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659–70.CrossRefPubMed
38.
Moreno-Aguilar G, Lichtenstein D. Lung ultrasound in the critically ill (LUCI) and the lung point: a sign specific to pneumothorax which cannot be mimicked. Crit Care. 2015;19:311.CrossRefPubMedPubMedCentral
39.
Peters JL, Belsham PA, Garrett CPO, Kurzer M. Doppler ultrasound technique for safer percutaneous catheterizatlon of the infraclavicular subclavian vein. Am J Surg. 1982;143(3):391–3.CrossRefPubMed
40.
Beheshti MV. A concise history of central venous access. Tech Vasc Interv Radiol. 2011;14(4):184–5.CrossRefPubMed
41.
Heidemann L, Nathani N, Sagana R, Chopra V, Hueng M. A contemporary assessment of mechanical complication rates and trainee perceptions of central venous catheter insertion. J Hosp Med. 2017;12(8):646–51.CrossRefPubMed
42.
International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37(7):1077–83.
43.
Millington SJ, Arntfield RT, Guo RJ, Koenig S, Kory P, Noble V, et al. The Assessment of Competency in Thoracic Sonography (ACTS) scale: validation of a tool for point-of-care ultrasound. Crit Ultrasound J. 2017;9(1):25.CrossRefPubMedPubMedCentral
44.
Phillips CT, Manning WJ. Advantages and pitfalls of pocket ultrasound vs daily chest radiography in the coronary care unit: a single-user experience. Echocardiography. 2017;34(5):656–61.CrossRefPubMed
45.
Ablordeppey EA, Drewry AM, Beyer AB, Theodoro DL, Fowler SA, Fuller BM, et al. Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2017;45(4):715-24.
46.
Miccini M, Cassini D, Gregori M, Gazzanelli S, Cassibba S, Biacchi D. Ultrasound-guided placement of central venous port systems via the right internal jugular vein: are chest x-ray and/or fluoroscopy needed to confirm the correct placement of the device? World J Surg. 2016;40(10):2353–8.CrossRefPubMed
47.
Killu K, Parker A, Coba V, Horst M, Dulchavsky S. Using ultrasound to identify the central venous catheter tip in the superior vena cava. ICU Dir. 2010;1(4):220–2.CrossRef
48.
Baviskar AS, Khatib KI, Bhoi S, Galwankar SC, Dongare HC. Confirmation of endovenous placement of central catheter using the ultrasonographic “bubble test”. Indian J Crit Care Med. 2015;19(1):38–41.CrossRefPubMedPubMedCentral
49.
Cortellaro F, Mellace L, Paglia S, Costantino G, Sher S, Coen D. Contrast enhanced ultrasound vs chest x-ray to determine correct central venous catheter position. Am J Emerg Med. 2014;32(1):78–81.CrossRefPubMed
50.
Duran-Gehring PE, Guirgis FW, McKee KC, Goggans S, Tran H, Kalynych CJ, et al. The bubble study: ultrasound confirmation of central venous catheter placement. Am J Emerg Med. 2015;33(3):315–9.CrossRefPubMed
51.
Gekle R, Dubensky L, Haddad S, Bramante R, Cirilli A, Catlin T, et al. Saline flush test: can bedside sonography replace conventional radiography for confirmation of above-the-diaphragm central venous catheter placement? J Ultrasound Med. 2015;34(7):1295–9.CrossRefPubMed
52.
Kamalipour H, Ahmadi S, Kamali K, Moaref A, Shafa M, Kamalipour P. Ultrasound for localization of central venous catheter: a good alternative to chest x-ray? Anesth Pain Med. 2016;6(5):e38834.CrossRefPubMedPubMedCentral
53.
Lanza C, Russo M, Fabrizzi G. Central venous cannulation: are routine chest radiographs necessary after B-mode and colour Doppler sonography check? Pediatr Radiol. 2006;36(12):1252–6.CrossRefPubMed
54.
Santarsia G, Casino FG, Gaudiano V, Mostacci SD, Bagnato G, Latorraca A, et al. Jugular vein catheterization for hemodialysis: correct positioning control using real-time ultrasound guidance. J Vasc Access. 2000;1(2):66–9.CrossRefPubMed
55.
Weekes AJ, Johnson DA, Keller SM, Efune B, Carey C, Rozario NL, et al. Central vascular catheter placement evaluation using saline flush and bedside echocardiography. Acad Emerg Med. 2014;21(1):65–72.CrossRefPubMed
56.
Weekes AJ, Keller SM, Efune B, Ghali S, Runyon M. Prospective comparison of ultrasound and CXR for confirmation of central vascular catheter placement. Emerg Med J. 2016;33(3):176–80.CrossRefPubMed
57.
Wen M, Stock K, Heemann U, Aussieker M, Kuchle C. Agitated saline bubble-enhanced transthoracic echocardiography: a novel method to visualize the position of central venous catheter. Crit Care Med. 2014;42(3):e231–3.CrossRefPubMed
58.
Alonso-Quintela P, Oulego-Erroz I, Rodriguez-Blanco S, Muniz-Fontan M, Lapena-Lopez-de Armentia S, Rodriguez-Nunez A. Location of the central venous catheter tip with bedside ultrasound in young children: can we eliminate the need for chest radiography? Pediatr Crit Care Med. 2015;16(9):e340–5.CrossRefPubMed
59.
Maury E, Guglielminotti J, Alzieu M, Guidet B, Offenstadt G. Ultrasonic examination: an alternative to chest radiography after central venous catheter insertion? Am J Respir Crit Care Med. 2001;164(3):403–5.CrossRefPubMed
60.
Park YH, Lee JH, Byon HJ, Kim HS, Kim JT. Transthoracic echocardiographic guidance for obtaining an optimal insertion length of internal jugular venous catheters in infants. Paediatr Anaesth. 2014;24(9):927–32.CrossRefPubMed
61.
Zanobetti M, Coppa A, Bulletti F, Piazza S, Nazerian P, Conti A, et al. Verification of correct central venous catheter placement in the emergency department: comparison between ultrasonography and chest radiography. Intern Emerg Med. 2013;8(2):173–80.CrossRefPubMed
Metadata
Title
Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis
Authors
Jasper M. Smit
Reinder Raadsen
Michiel J. Blans
Manfred Petjak
Peter M. Van de Ven
Pieter R. Tuinman
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-1989-x

Other articles of this Issue 1/2018

Critical Care 1/2018 Go to the issue

Letter

Extracorporeal membrane oxygenation offers long-term survival in childhood leukemia and acute respiratory failure

Research

Early application of continuous high-volume haemofiltration can reduce sepsis and improve the prognosis of patients with severe burns

Research

Clinical course, treatment and outcome of Pneumocystis pneumonia in immunocompromised adults: a retrospective analysis over 17 years

Letter

Pulmonary vein signal in mitral regurgitation

Research

Minimally invasive drainage in critically ill patients with severe necrotizing pancreatitis is associated with better outcomes: an observational study

Letter

The kinetic glomerular filtration rate is not interchangeable with measured creatinine clearance for prediction of piperacillin underexposure in critically ill patients with augmented renal clearance