Publication: Study on effectiveness of using right ventricle inflow parasternal long axis view in detecting supradiaphragmatic central venous catheter malposition in comparison to chest radiograph
Loading...
Date
2022
Authors
Shi, Phong Qiu
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Right ventricle inflow parasternal long axis view is one of the basic echocardiographic views that is easily performed bedside to visualize anterior cardiac structure such as tricuspid valve, right ventricle as well as right ventricle outflow tract. Likewise, we would like to explore the effectiveness of right ventricle inflow parasternal long axis view in determining the correct central venous catheter tip placement in comparison to conventional chest radiograph. As we know, that performing a bedside ultrasound is faster than X-ray, which involves confirming of placement. Methods: This is a cross-sectional study specially designed to determine the effectiveness of right ventricle inflow parasternal long axis view in determine correct central venous catheters tip placement. This study was conducted from June 2021 till December 2021. Convenient and probable sampling were used, and subjects were screened in general medical ward, intensive care unit and medical high dependency unit, which involved a total of 105 patient that fulfilled the inclusion criteria. Socio-demographic, based on age, gender, ethnicity, comorbidities, central venous catheter indication and types were recorded. Patient vital signs and any inotropic or ventilatory support were recorded as well. Bedside ultrasound performed by credential doctor/ investigator using apical 4 chambers view, right ventricle inflow parasternal long axis view as well as subcostal views (in certain difficult/poor echocardiography window patient) to visualize the tip of central venous catheter, each ultrasound clip was documented. Moreover, the contrast medium used in these studies was 5-10 cc normal saline aided for better visualization. Descriptive data reported as means and standard deviations for normally distributed data and as median for abnormally distributed data. Categorical data were reported in percentages and frequencies. Numerical data were presented as mean (SD) based on their normality distribution. The ratal agreement between first and second investigator was calculated based on Cohen’s kappa coefficient for interrater reliability. Results: Abnormal rapid arterial swirl sign in right ventricle inflow parasternal long axis view was not a sensitive sign (16.7%) but a very specific sign (91.9%) of central venous catheter malposition. There were no intraarterial central venous catheter malposition occurred. Right ventricle inflow parasternal long axis views successfully detected all intravenous central venous catheter tip position. Moreover, the “2 second rule” and the onset of rapid arterial swirl sign could not determine whether central venous catheter tip was correctly positioned. There was a moderate interrater disagreement between 1st and 2nd investigator with the kappa interrater reliability ratio of 0.456. Conclusions: Contrast enhanced ultrasound with right ventricle inflow parasternal long axis view is an accurate and reproducible tool to rule out central venous catheter malposition in patient. However, prospective studies performed on larger study sample are required to confirm our study result.