PDF(Pubmed)
Abstract：
BACKGROUND: Although guidelines and protocols are available for central venous access, existing methods lack specificity and sensitivity, especially when placing peripherally inserted central catheters (PICCs). We evaluated the feasibility of catheter detection in the right atrial cavity using transthoracic echocardiography (TTE) during PICC placement.
METHODS: This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications.
RESULTS: Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%-99.36%), 90% CI (55.50%-99.75%), 99%, and 75%, respectively.
CONCLUSIONS: TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.
METHODS: This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications.
RESULTS: Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%-99.36%), 90% CI (55.50%-99.75%), 99%, and 75%, respectively.
CONCLUSIONS: TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.
摘要：
背景：尽管指南和方案可用于中心静脉通路，现有方法缺乏特异性和敏感性，尤其是在放置经外周插入的中央导管（PICCs）时。我们评估了在PICC放置期间使用经胸超声心动图（TTE）在右心房腔中进行导管检测的可行性。
方法：这种单中心，回顾性研究纳入2022年1月至2023年3月期间接受PICC置管的连续患者.进行TTE以检测导管是否到达右心房腔。导管错位定义为胸部X线(CXR)上导管位置异常。主要终点是根据右心房腔中的导管检测预测导管错位。次要终点是优化导管放置和检查导管相关并发症。
结果：在确定的110名患者中，10例由于回声能力差和静脉通路失败而被排除在外。其余100例患者接受TTE的PICC置管。导管在90例患者的右心房腔中可视化。CXR检查显示7例导管错位。八名导管错位的患者在另一只手臂中接受了相同的手术。在两个病人中，由于解剖学原因，PICC放置失败。使用TTE检测导管错位,特异性，正预测值，阴性预测值为97%置信区间(CI；91.31%-99.36%)，90%CI（55.50%-99.75%），99%,75%,分别。
结论：TTE是检测PICC置管过程中导管错位和优化导管尖端定位的可靠工具。
方法：这种单中心，回顾性研究纳入2022年1月至2023年3月期间接受PICC置管的连续患者.进行TTE以检测导管是否到达右心房腔。导管错位定义为胸部X线(CXR)上导管位置异常。主要终点是根据右心房腔中的导管检测预测导管错位。次要终点是优化导管放置和检查导管相关并发症。
结果：在确定的110名患者中，10例由于回声能力差和静脉通路失败而被排除在外。其余100例患者接受TTE的PICC置管。导管在90例患者的右心房腔中可视化。CXR检查显示7例导管错位。八名导管错位的患者在另一只手臂中接受了相同的手术。在两个病人中，由于解剖学原因，PICC放置失败。使用TTE检测导管错位,特异性，正预测值，阴性预测值为97%置信区间(CI；91.31%-99.36%)，90%CI（55.50%-99.75%），99%,75%,分别。
结论：TTE是检测PICC置管过程中导管错位和优化导管尖端定位的可靠工具。
