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Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

Ablordeppey, Enyo A. MD, MPH1,2; Drewry, Anne M. MD, MSCI1; Beyer, Alexander B. MD, MPHS3; Theodoro, Daniel L. MD, MSCI2; Fowler, Susan A. MLIS4; Fuller, Brian M. MD, MSCI1,2; Carpenter, Christopher R. MD, MSCI2

doi: 10.1097/CCM.0000000000002188
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Objective: We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography.

Data Sources: PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov.

Study Selection: Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position.

Data Extraction: Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio.

Data Synthesis: Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77–0.86) and 0.98 (0.97–0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72–65.78) and 0.25 (0.13–0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high.

Conclusions: Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than chest radiography.

1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.

2Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO.

3Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI.

4Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO.

This study was performed at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, MO.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Ablordeppey’s institution received funding from a Washington University School of Medicine Faculty Scholars grant and the Foundation for Barnes Jewish Hospital grant. She received funding from American Association of Critical-Care Nurses. Dr. Drewry received support for article research from the National Institutes of Health (NIH) and the Foundation for Anesthesia Education and Research and the Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and KL2 TR000450 from the National Center for Advancing Translational Sciences (NCATS) of the NIH. Dr. Theodoro’s institution received funding from Siemens and GARFIELD. Dr. Fuller’s institution received funding from the Barnes-Jewish Hospital Foundation, Washington University Institute of Clinical and Translational Sciences (grant numbers: UL1 TR000448 and KL2 TR000450), and from the NCATS. He received support for article research from the NIH. He is supported by KL2 career development award. Dr. Carpenter disclosed working as faculty for Emergency Medical Abstracts and Best Evidence in Emergency Medicine, Deputy Editor-in-Chief for Academic Emergency Medicine, and Editorial Board Journal of the American Geriatrics Society. Drs. Theodoro, Fuller, and Carpenter conducted this research with resources from the Washington University Emergency Care Research Core, which receives funding from the Foundation for Barnes-Jewish Hospital. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: ablordeppey@wustl.edu

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