Korean J Crit Care Med.  2013 Nov;28(4):280-286. 10.4266/kjccm.2013.28.4.280.

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition

• Ahn H
• Kim G
• Cho B
• Jeong W
• You Y
• Ryu S
• Lee J
• Kim S
• Yoo I
• Cho Y

• KMID: 1977504
• DOI: http://doi.org/10.4266/kjccm.2013.28.4.280

Abstract

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Keyword

central venous catheterization; complication; emergency department; malposition; ultrasound

MeSH Terms

Catheterization, Central Venous*
Central Venous Catheters*
Emergencies
Humans
Jugular Veins
Prospective Studies
Radiography
Retrospective Studies
Subclavian Vein
Tertiary Care Centers
Thorax
Ultrasonography
Vena Cava, Superior