评估术后常规胸部X线片以确定永久性中心静脉导管尖端的正确位置。

Evaluation of routine postoperative chest roentgenogram for determination of the correct position of permanent central venous catheters tip.

作者信息

Salimi Fereshteh, Hekmatnia Ali, Shahabi Javad, Keshavarzian Amir, Maracy Mohammad Reza, Jazi Amir Hosein Davarpanah

机构信息

Department of Vascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

J Res Med Sci. 2015 Jan;20(1):89-92.

PMID:25767527

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4354071/

Abstract

BACKGROUND

Proper placement of central venous catheter (CVC) tip could reduce early and late catheter-related complications. Although the live fluoroscopy is standard of care for placement of the catheter, it is not available in many centers. Therefore, the present study evaluated the sensitivity and specificity of bedside chest X-ray (CXR) for proper positioning of the catheter tip.

MATERIALS AND METHODS

A total of 82 adult patients undergoing elective placement of tunneled CVC were enrolled in this study during 2010-2012. The catheter tip position was evaluated by postoperative bedside chest radiographs as well as trans-thoracic echocardiogram as definite diagnostic tool. The catheter position was considered correct if the tip was positioned in the right atrium both in CXR or echocardiography. Finally, CXRs interpreted by expert radiologist. Thus findings were compared by echocardiography. Sensitivity, specificity, accuracy, positive, and negative predictive values were calculated. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL), and P < 0.05 considered as significant.

RESULTS

The patients were 57.37 ± 18.91 years of age, weighed 65.79 ± 15.58 kg and were 166.36 ± 9.91 cm tall. Sensitivity and specificity of CXR for proper catheter tip position were 74.3% and 58.3%, respectively. Positive and negative predictive values were 91.2% and 28%. In addition accuracy, positive likelihood ratio, and negative likelihood ratio were 71.9%, 1.78, and 2.27 respectively.

CONCLUSION

Bedside CXR alone does not reliably predict malpositioning after CVC placement.

摘要

背景

中心静脉导管（CVC）尖端的正确放置可减少早期和晚期导管相关并发症。虽然实时荧光透视检查是导管放置的标准护理方法，但许多中心无法进行。因此，本研究评估了床边胸部X线（CXR）对导管尖端正确定位的敏感性和特异性。

材料与方法

2010年至2012年期间，共有82例接受隧道式CVC择期放置的成年患者纳入本研究。通过术后床边胸部X线片以及经胸超声心动图作为明确的诊断工具来评估导管尖端位置。如果在CXR或超声心动图中导管尖端位于右心房，则认为导管位置正确。最后，由专业放射科医生解读CXR。因此，将结果与超声心动图进行比较。计算敏感性、特异性、准确性、阳性和阴性预测值。使用SPSS 16版（SPSS公司，伊利诺伊州芝加哥）分析数据，P < 0.05被认为具有统计学意义。