Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Ann Emerg Med. 2014 Jun;63(6):678-83. doi: 10.1016/j.annemergmed.2013.12.020. Epub 2014 Jan 15.
Inadvertent arterial placement of a femoral venous catheter may result in serious morbidity, including limb necrosis. The Flush the Line and Ultrasound the Heart (FLUSH) test is visualization of the heart by a subxiphoid ultrasonic view while the central catheter is flushed with agitated saline solution. We wish to determine whether the FLUSH test can verify proper femoral venous line placement.
We prospectively studied a convenience sample of children undergoing cardiac catheterization, for whom both femoral venous and arterial access were part of their standard care. The cardiologist flushed manually agitated saline solution through each catheter in randomized sequence while the blinded physician sonographer recorded the presence or absence of right atrial opacification. We calculated the sensitivity and specificity of the FLUSH test relative to our reference standard, the cardiologist's fluoroscopic visualization of catheter wire placement.
Of the 51 subjects enrolled, the FLUSH test was 100% sensitive (95% confidence interval 95% to 100%) and 90.3% specific (95% confidence interval 81% to 96%) in confirming femoral catheter placement. In no case was an arterial flush misidentified as a femoral flush. The interrater reliability of the test was strong: κ 0.82 for all images and 0.9 for those of good quality.
The FLUSH test is simple and reliable, and appears to accurately confirm femoral venous line placement.
股静脉置管时若不慎穿入股动脉，可能导致严重的并发症，包括肢体坏死。冲洗管腔和超声心动图（Flush the Line and Ultrasound the Heart，FLUSH）试验是指在中心导管用搅动的生理盐水冲洗时，通过剑突下超声切面观察心脏。我们旨在确定 FLUSH 试验是否能验证股静脉置管的正确位置。
我们前瞻性地研究了一组接受心导管插入术的儿童的便利样本，这些儿童的股静脉和股动脉通路都是其标准治疗的一部分。心脏病专家以随机顺序手动冲洗搅动的生理盐水溶液通过每个导管，而盲法超声医师记录右心房是否显影。我们计算了 FLUSH 试验相对于我们的参考标准（心脏病专家透视观察导管导丝位置）的敏感性和特异性。
在 51 名入组的受试者中，FLUSH 试验在确认股静脉置管方面的敏感性为 100%（95%置信区间为 95%至 100%），特异性为 90.3%（95%置信区间为 81%至 96%）。在任何情况下，动脉冲洗都没有被错误地识别为股静脉冲洗。该试验的观察者间可靠性很强：所有图像的 κ 值为 0.82，质量好的图像的 κ 值为 0.9。
FLUSH 试验简单可靠，似乎能准确地确认股静脉置管位置。
