Intensive Observation Unit, Careggi University Hospital, Florence, Italy.
Intern Emerg Med. 2013 Mar;8(2):173-80. doi: 10.1007/s11739-012-0885-7. Epub 2012 Dec 16.
In 210 consecutive patients undergoing emergency central venous catheterization, we studied whether an ultrasonography examination performed at the bedside by an emergency physician can be an alternative method to chest X-ray study to verify the correct central venous catheter placement, and to identify mechanical complications. A prospective, blinded, observational study was performed, from January 2009 to December 2011, in the emergency department of a university-affiliated teaching hospital. Ultrasonography interpretation was completed during image acquisition; ultrasound scan was performed in 5 ± 3 min, whereas the time interval between chest radiograph request and its final interpretation was 65 ± 74 min p < 0.0001. We found a high concordance between the two diagnostic modalities in the identification of catheter position (Kappa = 82 %, p < 0.0001), and their ability to identify a possible wrong position showed a high correlation (Pearson's r = 0.76 %, p < 0.0001) with a sensitivity of 94 %, a specificity of 89 % for ultrasonography. Regarding the mechanical complications, three iatrogenic pneumothoraces occurred, all were correctly identified by ultrasonography and confirmed by chest radiography (sensitivity 100 %). Our study showed a high correlation between these two modalities to identify possible malpositioning of a catheter resulting from cannulation of central veins, and its complications. The less time required to perform ultrasonography allows earlier use of the catheter for the administration of acute therapies that can be life-saving for the critically ill patients.
在 210 例连续进行紧急中心静脉置管的患者中，我们研究了由急诊医师在床边进行的超声检查是否可以替代胸部 X 光检查来验证正确的中心静脉导管位置，并识别机械并发症。这是一项前瞻性、盲法、观察性研究，于 2009 年 1 月至 2011 年 12 月在一所大学附属医院的急诊科进行。超声解释是在图像采集过程中完成的；超声扫描用时 5±3 分钟，而请求胸部 X 光检查到最终解释的时间间隔为 65±74 分钟（p<0.0001）。我们发现两种诊断方法在识别导管位置方面具有高度一致性（Kappa=82%，p<0.0001），并且它们识别可能错误位置的能力具有高度相关性（Pearson r=0.76%，p<0.0001），超声检查的敏感性为 94%，特异性为 89%。关于机械并发症，发生了 3 例医源性气胸，所有这些均通过超声检查正确识别，并通过胸部 X 光检查证实（敏感性 100%）。我们的研究表明，这两种方法在识别因中央静脉插管引起的导管可能错位及其并发症方面具有高度相关性。超声检查所需的时间较短，可更早地将导管用于急性治疗，这对于重症患者的生命至关重要。
