Document Detail

Is traditional reading of the bedside chest radiograph appropriate to detect intraatrial central venous catheter position?
MedLine Citation:
PMID:  18641117     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Traditionally, the positioning of central venous catheters (CVCs) outside the right atrium (RA) in patients receiving intensive care is determined by surrogate landmarks on bedside chest radiographs (CXRs). The validity of this method was examined by comparing readings of radiologists with the results of transesophageal echocardiography (TEE). METHODS: Prospective study at university hospital. Two hundred thirteen adults scheduled for cardiothoracic surgery were randomized to right or left internal jugular vein catheterization under ECG guidance. One senior radiologist and two radiologists in training independently read the CXRs, and determined whether the CVC tip ended in the RA and measured the vertical distance from the CVC tip to the carina (TC-distance). RESULTS: Two hundred twelve CVC tips could be identified by TEE. Only left-sided CVCs (n = 5) ended in the upper RA (2.4%). Three of those patients were shorter than 160 cm. Specificity was 94% for senior radiologist, 44% for the first radiologist in training, and 60% for the second radiologist in training. The TC-distance of intraatrial catheters was 39, 55, 59, 80, and 83 mm, respectively. Thus, a TC-distance < or = 55 mm ensured extraatrial tip position in four of five intraatrial CVCs (80%, p = 0.002). The TC-distance of extraatrial catheters ranged from - 26 to 102 mm. CONCLUSIONS: Reading of a bedside CXR alone is not very accurate to identify intraatrial CVC tip position. TC-distance is a helpful marker, and its specificity is as good as that of an experienced radiologist if a cutoff value of 55 mm is chosen.
Melanie Wirsing; Claudia Schummer; Rotraud Neumann; Jörg Steenbeck; Peter Schmidt; Wolfram Schummer
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Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2008-07-18
Journal Detail:
Title:  Chest     Volume:  134     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-09     Completed Date:  2008-10-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  527-33     Citation Subset:  AIM; IM    
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany.
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MeSH Terms
Aged, 80 and over
Catheterization, Central Venous / methods*
Echocardiography, Transesophageal
Heart Atria / radiography*,  ultrasonography*
Jugular Veins / radiography,  ultrasonography
Longitudinal Studies
Middle Aged
Observer Variation
Prospective Studies
Radiography, Thoracic / methods*
Reproducibility of Results
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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