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Agitated Saline Bubble–Enhanced Transthoracic Echocardiography: A Novel Method to Visualize the Position of Central Venous Catheter

Wen, Ming MD; Stock, Konrad MD; Heemann, Uwe MD; Aussieker, Mario MD; Küchle, Claudius MD

doi: 10.1097/CCM.0000000000000130
Online Brief Report

Objectives: The purpose of this study is to describe a novel method to visualize the position of central venous catheters, which is safe, expeditious, and less expensive than the routine postprocedural chest radiograph.

Design: Retrospective comparative study.

Setting: Dialysis Center of the Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

Patients: Two hundred and two adult patients undergoing central venous catheter placement for dialysis, plasmapheresis, or administration of medication and solutions.

Interventions: None.

Measurements and Main Results: Data of 202 adult patients with 219 central venous catheterizations were retrospectively analyzed. Each catheter insertion was followed by an agitated saline bubble–enhanced transthoracic echocardiography, which was used to localize the tip of the catheter. The position of catheter was then controlled by chest radiograph in all cases. During the 13-month study period, two catheter malpositions occurred. Both were identified by agitated saline bubble–enhanced transthoracic echocardiography and confirmed by chest radiograph. The mean time between catheter insertion and chest radiograph control (28.3 min) was clearly longer than agitated saline bubble–enhanced transthoracic echocardiography (3.2 min) (p < 0.001). The total costs of the procedure were reduced by 86.7–95.0%. Specific complications related to the procedure were not observed.

Conclusions: The results revealed that the accuracy of agitated saline bubble–enhanced transthoracic echocardiography is equivalent to the chest radiograph. It offers a safe, cost-effective, expeditious alternative to routine chest radiograph for position controls of central venous catheters.

All authors: Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

Dr. Wen analyzed the data and wrote the article. Drs. Wen, Aussieker, and Küchle participated in clinical conduct, data collection, and analysis. Drs. Stock and Heemann contributed to data analysis and edited the article. Dr. Küchle developed the scientific concept. All authors have read and approved the submission.

The authors have disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins