Real time wire localization by ultrasound during central line insertion improves accurate positioning in all upper torso sites

Ori Galante; Re'em Sadeh; Alexander Smoliakov; Alona Muraveva; Yaniv Almog; Eyal Schneider; Amit Frenkel; Lior Fuchs

doi:10.1016/j.jcrc.2021.10.009

Real time wire localization by ultrasound during central line insertion improves accurate positioning in all upper torso sites

J Crit Care. 2022 Feb:67:79-84. doi: 10.1016/j.jcrc.2021.10.009. Epub 2021 Oct 28.

Authors

Ori Galante¹, Re'em Sadeh², Alexander Smoliakov³, Alona Muraveva³, Yaniv Almog⁴, Eyal Schneider⁵, Amit Frenkel⁶, Lior Fuchs⁴

Affiliations

¹ Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: ori.galante@gmail.com.
² Faculty of Health Sience, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
³ Institute of Diagnostic Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
⁴ Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
⁵ Faculty of Health Sience, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
⁶ General Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.

PMID: 34717163
DOI: 10.1016/j.jcrc.2021.10.009

Abstract

Purpose: To investigate whether point of care ultrasound can improve central venous catheter tip positioning.

Material and methods: A single center retrospective case control study. We compared the precision of central venous catheter tip positioning between two intensive care units while in only one of the units, we used point of care ultrasound for guidewire identification.

Results: 207 cases in which central venous catheter was inserted using point of care ultrasound guided method, compared to 192 controls. The primary outcome of correct placement of the central venous catheter tip was significantly higher in the point of care ultrasound guided group (97.6% vs 88.0% p = 0.001). Central venous catheter tip was located too low among 12% of patients in the control group while in only 2.4% of patients in the point of care ultrasound group (p = 0.001). Logistics regression analysis revealed that the correct placement of central venous catheter tip in the point of care ultrasound group versus the control group had an odds ratio of 4.9 (CI 1.6-14.5 P = 0.004).

Conclusion: Point of care ultrasound for guidewire identification and localization, while inserting central venous catheter from all upper torso sites, improves precision positioning.

Keywords: Central venous catheter; Chest x-ray; Point of care ultrasound.

MeSH terms

Case-Control Studies
Catheterization, Central Venous* / methods
Central Venous Catheters*
Humans
Retrospective Studies
Torso
Ultrasonography, Interventional / methods