Is Traditional Reading of Bedside Chest Radiograph Appropriate to Detect Intra-atrial Central Venous Catheter Position?
Chest. 2008 Jul 18;
Authors: Wirsing M, Schummer C, Neumann R, Steenbeck J, Schmidt P, Schummer W
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.
PMID: 18641117 [PubMed - as supplied by publisher]