PDF(Pubmed)
Abstract：
To determine the tip position of the central venous catheter (CVC) in patients with dialysis, the guidelines recommend that it be determined using chest radiography (CXR) after catheterization, without fluoroscopy. However, some researchers have proposed that transthoracic echocardiography (TTE) can replace CXR, but this has not been widely adopted. This study aimed to determine which of the two aforementioned methods is more suitable for locating the tip position of the CVC. This prospective study included 160 patients who underwent hemodialysis at our hospital from March 2021 to December 2022. After inserting the CVC through the internal jugular vein, we used transthoracic echocardiography and CXR to determine the tip of the CVC and compared the results with those of computed tomography (CT). In the comparison between TTE and CXR for locating the CVC tip, we obtained three main findings. (1) TTE was associated with fewer misdiagnosed cases than CXR. (2) TTE provided higher sensitivity (similar sensitivity in position 2), specificity, positive/negative predictive values, and accuracy than CXR. (3) When comparing the receiver operating characteristic curves of TTE and CXR, the area under the curve (95% confidence interval) for the former was larger. Additionally, we made anatomical discoveries: the \"hyperechoic triangle\" recognized by TTE was equivalent to the entrance of the superior vena cava into the right atrium shown by transesophageal transthoracic echocardiography. TTE is more suitable than CXR as the first examination for CVC tip localization, as it improves diagnostic accuracy and reduces X-ray radiation damage.
摘要：
为了确定透析患者中心静脉导管（CVC）的尖端位置，指南建议在导管插入后使用胸部X线照相术（CXR）确定，没有透视。然而,一些研究人员提出，经胸超声心动图（TTE）可以替代CXR，但这并没有被广泛采用。这项研究旨在确定上述两种方法中哪一种更适合定位CVC的尖端位置。这项前瞻性研究包括2021年3月至2022年12月在我们医院接受血液透析的160名患者。通过颈内静脉插入CVC后，我们使用经胸超声心动图和CXR来确定CVC的尖端，并将结果与计算机断层扫描（CT）的结果进行比较。在定位CVC尖端的TTE和CXR之间的比较中，我们获得了三个主要发现。（1）与CXR相比，TTE与误诊病例较少。（2）TTE提供更高的灵敏度（位置2的灵敏度相似），特异性，阳性/阴性预测值，和精度比CXR。（3）比较TTE和CXR的接收机工作特性曲线时，前者的曲线下面积(95%置信区间)较大.此外,我们在解剖学上发现:经食管经胸超声心动图显示的“高回声三角”相当于上腔静脉进入右心房。TTE比CXR更适合作为CVC头端定位的首次检查，因为它提高了诊断准确性并减少了X射线辐射损伤。
