Although routine chest radiographs (CXR) to verify correct central venous catheter (CVC) position and exclude pneumothorax are commonly performed, emerging evidence suggests that this practice can be replaced by point of care ultrasound (POCUS). POCUS is advantageous over CXR because it avoids radiation while verifying correct placement and lack of pneumothorax without delay. We hypothesize that a knowledge translation gap exists in this area. We aim to describe the current clinical practice regarding POCUS alone for CVC position confirmation and pneumothorax exclusion as compared with chest radiography.
We used a modified Dillman technique to conduct a brief web-based survey to Critical Care Medicine and Emergency Medicine physicians (targeted group of early adopters) evaluating the current practice related to CVC position confirmation and PTX exclusion via CXR or POCUS.
Of 200 post-training clinicians contacted, 136 (68%) responded to the survey. For routine CVC confirmation and PTX evaluation, 50.7% of Critical Care Medicine physicians and 65.4% of Emergency Medicine physicians reported using CXR alone while 49.3% and 33.1% respectively reported using CXR and ultrasound together. Though 84.6% of clinicians use ultrasound for CVC insertion “most of the time” or “always,” none use ultrasound alone for CVC position confirmation, and only 1% has used ultrasound alone for PTX exclusion.
Though data support its utility and advantages for POCUS as a sole modality for CVC position confirmation and PTX evaluation, POCUS is rarely used for this indication. We identified several perceived barriers toward widespread utilization suggesting areas for dissemination and implementation strategy development that will benefit patient care practices.
*Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, Saint Louis, Missouri
†Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, Missouri
Address reprint requests to Enyo A. Ablordeppey, MD, MPH, 660 South Euclid Avenue CB 8072, St Louis, MO 63110 E-mail: firstname.lastname@example.org
Received 22 May, 2018
Revised 6 June, 2018
Accepted 2 July, 2018
EAA was supported by Washington University School of Medicine Faculty grant. Drs EAA, LXT, and DLT conducted this research with resources from the Washington University Emergency Care Research Core, which receives funding from the Foundation for Barnes-Jewish Hospital. AMD was supported by the Division of Clinical and Translational Research of the Department of Anesthesiology at Washington University School of Medicine, and the Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and KL2 TR000450 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). BMF was supported by a KL2 TR000450 from the National Center for Advancing Translational Sciences of the NIH. RTG was supported by grant 1 R18 HS025052-01 from the Agency for Healthcare Research and Quality, grant P30DK092950 from the NIH/National Institute of Diabetes and Digestive and Kidney Disorders, Washington University Center for Diabetes Translation Research, and grant 3767 from the Barnes Jewish Hospital Foundation. The authors report no conflicts of interest.
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