Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
Azienda Ospedaliero Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, PI, Italy.
Crit Care. 2022 Apr 21;26(1):113. doi: 10.1186/s13054-022-03985-3.
To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard.
A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients.
As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view.
The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.
评估术前增强经胸超声心动图（CE-TTE）和术后胸部 X 线（CXR）在评估中心静脉导管（CVC）尖端位置中的作用，以经食管超声心动图（TEE）为金标准。
对 111 例行择期心脏手术的患者进行前瞻性单中心观察性研究，这些患者需要经锁骨下静脉置管。在采用地标技术插入 CVC 末端后，通过心尖四腔和上腹部双腔声学视图进行增强 TTE 以评估导管尖端位置；然后进行 TEE 检查，并将其作为参考技术。所有患者均获得术后 CXR。
根据 TEE，74 例（67%）导管尖端正确放置，37 例（33%）放置不当。考虑到血管内和心内错位，8 例通过心尖四腔视图的 CE-TTE、36 例通过上腹部双腔声学视图的 CE-TTE、12 例通过 CXR 检测到。对于检测导管尖端错位，与心尖四腔视图的 CE-TTE 或 CXR 相比，上腹部双腔声学视图的 CE-TTE 是最准确的方法，其检测敏感性为 97%、特异性为 90%、诊断准确性为 92%。与 TEE 的一致性为 79%（p<0.001）。
上腹部双腔声学视图的 CE-TTE 与 TEE 之间的一致性表明，前者可作为确保中心静脉置管后导管尖端正确定位的标准技术，以优化医院资源的利用并最大限度地减少辐射暴露。
