Can Ultrasound be Used to Verify CVC Position and to Exclude Pneumothorax?

Not Applicable

Terminated

• Conditions: Catheterization, Central Venous
• Interventions: Procedure: Ultrasound

• Registration Number: NCT00388375
• Lead Sponsor: Christiana Care Health Services

Brief Summary

The purpose of this study is to determine if emergency room physicians can use bedside ultrasound to quickly determine the proper placement of a central venous catheter and to evaluate for complications such as a punctured lung.

Detailed Description

Central venous catheterization (CVC) of the subclavian or internal jugular veins is a common procedure performed in the emergency department (ED). This procedure is followed by complications in 0.3 to 12% of cases. Pneumothorax (PTX) and catheter-tip misplacement can occur. The diagnosis of these complications requires a chest radiograph (CXR). In certain cases, CXR may be time-consuming, requiring more than 30 minutes. This could be harmful in the case of critically ill patients. Moreover, several investigators have questioned the need of routine post-procedural CXR in the absence of clinical complications.

Recent data has shown that ultrasound can accurately detect PTX in critically ill patients. Furthermore, bedside ultrasound is an easy technique to investigate the subclavian and internal jugular veins, and can improve the success rate of catheter insertion. Ultrasound also allows visualization of central venous catheters in vivo. Ultrasound has been reported as a tool to detect catheterization complications and misplacement when performed by ICU physicians, but has never been studied in the ED.

This method could be valuable in hemodynamically unstable patients, who quickly need a CVC for the measurement of central venous pressure, immediate fluid resuscitation, and infusion of vasoactive medications. Similarly, bedside ultrasound examination could quickly confirm PTX and allow immediate chest tube insertion in case of respiratory distress after catheter insertion.

We hypothesize that bedside ultrasound examination performed by ED physicians could accurately detect placement of the CVC and the presence or absence of a PTX after catheterization of the jugular and subclavian veins.

Study Timeline

• Study Start: 2006-10
• Study First Submitted: 2006-10-12
• Study First Submitted QC: 2006-10-12
• Study First Posted: 2006-10-16
• Primary Completion: 2008-12
• Study Completion: 2008-12
• Status Verified: 2012-11
• Last Update Submitted: 2014-10-17
• Last Update Posted: 2014-10-20

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 23

Inclusion Criteria

• Male or female 18 years or older
• Signed consent
• In need of subclavian or internal jugular central line placement

Exclusion Criteria

• Any subject who refuses or whose family refuses to sign consent
• Any subject in whose immediate transfer from the care of the ED to another location is mandated by clinical presentation
• Any subject under the age of 18
• Any subject being evaluated for chest trauma.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
CVC Internal Jugular or Subclavian Vein	Ultrasound	-

Primary Outcome Measures

Name	Time	Method
The presence or absence of PTX as detected by US and CXR	10 minutes
The presence or absence of a misplaced CVC as detected by US and CXR.	10 Minutes

Secondary Outcome Measures

Name	Time	Method
Time needed to complete the US exam and CXR	varies

Trial Locations

Locations (1)

Christiana Care Heath System; 🇺🇸 Newark, Delaware, United States