Bedside ultrasound can safely eliminate the need for chest radiographs after central venous catheter placement: CVC sono in the surgical ICU (SICU).

BACKGROUND: Real-time ultrasound guidance of central venous catheter (CVC)/peripherally inserted central catheter (PICC) insertion improves safety and efficacy. We hypothesized that a more robust ultrasound surveillance technique incorporating thoracic, vascular, and cardiac views-the CVC sono-would avoid the need for chest radiography to realize cost and efficiency gains.

METHODS: We conducted a prospective data collection in a high-volume, urban, academic SICU. A single surgical intensivist, blinded to the results of chest radiography, performed all CVC sonos post-insertion. Catheter malposition was defined as location extrinsic to the superior vena cava and determined by a board-certified radiologist on chest radiography. CVC sono consisted of (1) mechanical complications screen (hemo-, pneumothorax), (2) intravenous tip screen, (3) intracardiac tip screen. The result of CVC sono was compared with chest radiography.

RESULTS: CVC sono evaluated 83 catheters (42 CVCs and 41 PICCs) and was considered technically adequate in 59 (71%). Incomplete studies were significantly more common in those with chest tubes (P = 0.02), but not in those with cervical collars (P = 0.07), an open abdomen (P = 0.28), or BMI > 40 (P = 0.33). Mean CVC sono time was 10.8 min, compared with chest radiography of 75.3 min (P < 0.001). No hemo-pneumothoraces developed. Presence of multiple indwelling central catheters (>1 CVC) trended for inaccurate CVC sono for catheter malposition (accuracy: 79% versus 93%, P = 0.11).

CONCLUSION: A novel ultrasound technique, CVC sono eliminated the need for chest radiography in most patients after CVC/PICC insertion, saving time and money. Those with multiple indwelling central catheters may still require post-insertion conventional chest radiography.