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World Journal of Emergency Medicine ›› 2017, Vol. 8 ›› Issue (1): 25-28.doi: 10.5847/wjem.j.1920-8642.2017.01.004

• Original Articles • Previous Articles     Next Articles

Simplified point-of-care ultrasound protocol to confirm central venous catheter placement: A prospective study

Sean P. Wilson1(), Samer Assaf1, Shadi Lahham1, Mohammad Subeh1, Alan Chiem2, Craig Anderson1, Samantha Shwe1, Ryan Nguyen1, John C. Fox1   

  1. 1 Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
    2 Department of Emergency Medicine, University of California, Sylmar, Los Angeles, California 91342, USA
  • Received:2016-03-06 Accepted:2016-09-08 Online:2017-03-15 Published:2017-03-15
  • Contact: Sean P. Wilson


BACKGROUND: The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation.

METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC.

RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8% (95%CI 77.1%-93.5%) and specificity of 100% (95%CI 15.8%-100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes (IQR 10-29) and 32 minutes (IQR 19-45), respectively.

CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a confirmatory CXR.

Key words: Point-of-care ultrasound, Emergency ultrasound, Central venous access