Ultrasound versus conventional chest radiography after ultrasound guided insertion of a central line

Methods Adult patients in need for a CVC could be included. All CVC ́s were inserted under direct in plane US guidance. After insertion US was used to screen for correct or incorrect CVC position (in the case of a CVC in the Internal Jugular Vein (IJV) the ipsilateral subclavian vein (SCV) and in case of a CVC in the SCV the ipsilateral IJV was examined. On the ipsilateral side the two upper “blue points” were examined to rule out a pneumothorax. Finally cardiac ultrasound (CUS) was used to chech correct or incorrect CVC position in the heart or inferior cava vein and with the use of 5 cc agitated saline the pattern of microbubbles in the right atrium was recorded to confrim proper position. The time needed to obtain a CCR was noted. The results of the CCR were compared to the US results in a 2 x 2 table (US correct and incorrect position versus CCR correct and incorrect position). Results 46 Patients were included: 3 SCV and 43 IJV CVC ́s were inserted. The results of US and CCR in detecting pneumothorax were equal (n = 0). In 1 patient no CUS view could be obtained, in the other 45 the results of CCR and US were the same (correct position of the CVC). The sensitivity of US for detecting propper CVC position was 1,0 (0,9-1.0). The mean time needed waiting for the result of the CCR was 20 (0-195) minutes. we excluded the waiting time for CCR in 1 patient during a hospital system faliure for 2 days.