Point‐of‐care Ultrasound–guided Central Venous Catheter Confirmation in Ultrasound Nonexperts. Issue 3 (13th October 2020)

• Record Type: Journal Article
• Authors: Ablordeppey, Enyo A.; Drewry, Anne M.; Anderson, Adam L.; Casali, Diego; Wallace, Laura A.; Kane, Deborah S.; Tian, LinLin; House, Stacey L.; Fuller, Brian M.; Griffey, Richard T.; Theodoro, Daniel L.
• Editors: Jordan, Jaime
• Is Part Of: AEM education and training. Volume 5:Issue 3(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-10-13
• Subjects: Emergency medicine -- Study and teaching -- Periodicals; Emergency medicine -- Study and teaching -- United States -- Periodicals; Periodicals; 616.025
• DOI: 10.1002/aet2.10530
• Languages: English
• ISSNs: 2472-5390

Abstract

Abstract: Objective: Emerging evidence suggests that chest radiography (CXR) following central venous catheter (CVC) placement is unnecessary when point‐of‐care ultrasound (POCUS) is used to confirm catheter position and exclude pneumothorax. However, few providers have adopted this practice, and it is unknown what contributing factors may play a role in this lack of adoption, such as ultrasound experience. The objective of this study was to evaluate the diagnostic accuracy of POCUS to confirm CVC position and exclude a pneumothorax after brief education and training of nonexperts. Methods: We performed a prospective cohort study in a single academic medical center to determine the diagnostic characteristics of a POCUS‐guided CVC confirmation protocol after brief training performed by POCUS nonexperts. POCUS nonexperts (emergency medicine senior residents and critical care fellows) independently performed a POCUS‐guided CVC confirmation protocol after a 30‐minute didactic training. The primary outcome was the diagnostic accuracy of the POCUS‐guided CVC confirmation protocol for malposition and pneumothorax detection. Secondary outcomes were efficiency and feasibility of adequate image acquisition, adjudicated by POCUS experts. Results: Twenty‐six POCUS nonexperts collected data on 190 patients in the final analysis. There were five (2.5%) CVC malpositions and six (3%) pneumothoraxes on CXR. The positive likelihood ratios of POCUS for malposition detection and pneumothorax were 12.33 (95% confidence interval [CI] = 3.26 to 46.69) and 3.41 (95% CI = 0.51 to 22.76), respectively. The accuracy of POCUS for pneumothorax detection compared to CXR was 0.93 (95% CI = 0.88 to 0.96) and the sensitivity was 0.17 (95% CI = 0.00 to 0.64). The median (interquartile range) time for CVC confirmation was lower for POCUS (9 minutes [8.5–9.5 minutes]) compared to CXR (29 minutes [1–269 minutes]; Mann‐Whitney U, p < 0.01). Adequate protocol image acquisition was achieved in 76% of the patients. Conclusion: Thirty‐minute training of POCUS in nonexperts demonstrates adequate diagnostic accuracy, efficiency, and feasibility of POCUS‐guided CVC position confirmation, but not exclusion of pneumothorax.