Rath G P, Bithal P K, Toshniwal G R, Prabhakar H, Dash H H
Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
Br J Anaesth. 2009 Apr;102(4):499-502. doi: 10.1093/bja/aep021. Epub 2009 Feb 25.
The most common misplacement during subclavian vein (SCV) catheterization is into the ipsilateral internal jugular vein (IJV). Chest radiography is the gold standard for the confirmation of correct placement. However, it is time-consuming and has the disadvantage of radiation exposure. We assessed the sensitivity and specificity of our previously reported 'flush test' for confirming correct central line placement.
All neurosurgical patients who underwent successful SCV catheterization on the right side by an infraclavicular approach were enrolled in this study. The flush test was performed by injecting 10 ml of normal saline in the distal port of catheter, while anterior angle of ipsilateral neck was palpated by an independent observer. A thrill of fluid elicited on the palm of hand (positive test) was suggestive of misplaced catheter into ipsilateral IJV. This was confirmed with chest fluoroscopy.
SCV catheterization was performed in 570 patients. The flush test was positive in 19 patients (3.3%) and negative in 551 patients (96.7%). There were 26 (4.6%) misplacements as detected by chest radiography; 19 entered the IJV (3.3%) and seven the contralateral SCV (1.2%). In all patients who had a misplaced catheter into the ipsilateral IJV, the flush test results were positive, whereas the results were negative in patients who had normally placed catheter or misplaced catheter elsewhere. It was found that the test had 100% sensitivity and specificity to detect misplacement of SCV catheter into the ipsilateral IJV.
Saline flush test is a simple and sensitive bedside test that successfully detects misplaced SCV catheters into ipsilateral IJV.
锁骨下静脉（SCV）置管过程中最常见的误置是进入同侧颈内静脉（IJV）。胸部X线摄影是确认正确置管位置的金标准。然而，它耗时且有辐射暴露的缺点。我们评估了我们之前报道的用于确认中心静脉导管正确置管位置的“冲洗试验”的敏感性和特异性。
所有通过锁骨下途径成功进行右侧SCV置管的神经外科患者均纳入本研究。冲洗试验通过在导管远端端口注入10ml生理盐水进行，同时由一名独立观察者触诊同侧颈部前角。手掌感觉到液体波动（试验阳性）提示导管误置入同侧IJV。这通过胸部荧光透视得以证实。
对570例患者进行了SCV置管。冲洗试验19例（3.3%）为阳性，551例（96.7%）为阴性。胸部X线摄影检测到26例（4.6%）误置；19例进入IJV（3.3%），7例进入对侧SCV（1.2%）。在所有导管误置入同侧IJV的患者中，冲洗试验结果为阳性，而导管位置正常或误置入其他部位的患者结果为阴性。发现该试验检测SCV导管误置入同侧IJV的敏感性和特异性均为100%。
生理盐水冲洗试验是一种简单且敏感的床旁试验，能成功检测出误置入同侧IJV的SCV导管。
