[How Accurate is a Chest Radiograph to Demonstrate the Position Of CVP Line]

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Acknowledgement

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Abstract

The purpose of this study was to determine, first, the accuracy with which radiologists reading posteroanterior chest radiographs differentiate whether a central venous line is in the superior vena cava or the azygos vein and, second, the circumstances in which radiologists may omit the lateral view to determine the position of a central venous line. Twenty-four radiologists evaluated 60 posteroanterior chest radiographs to determine the position of a central venous line in the superior vena cava or azygos vein. Investigators evaluated the appearance of the central venous lines to refine rules for determining central venous line position on a frontal radiograph and omitting the lateral view. The accuracy of posteroanterior radiography for determining central venous line position was 90% at one study location and 85.5% at the other. No central venous line in the azygos vein extended more than 10.9 mm caudal to the cephalic edge of the right main bronchus. No central venous line in the superior vena cava had a down-the-barrel or curved appearance at the caudal edge. For central venous lines extending at least 15 mm caudal to the cephalic edge of the right main bronchus and having no down-the-barrel or curved caudal appearance, categorization was nearly 100% accurate. Therefore, if desired to save radiation exposure and cost, it may be feasible to omit lateral views in radiography of patients with central venous lines extending at least 15 mm caudal to the cephalic edge of the right main bronchus in whom the caudal edge does not have a down-the-barrel or curved appearance.

Table of Contents

ABSTRACT1

CHAPTER I: INTRODUCTION3

Background3

Indications for Central venous pressure (Internal Jugular Vein Cannulation)4

Confirming the position of the central venous pressure tip:4

Seldinger technique for CVP insertions:7

CVP Lines8

Peripheral Venous Access10

Midline Peripheral Catheters11

Central Catheters, Peripherally Inserted12

Central Catheters, Tunnelled13

Central Catheters, Implanted Ports14

Types of CVP16

CHAPTER II: MATERIALS AND METHODS19

Search Strategy19

Inclusion and Exclusion Criteria19

Overall incidence20

Insertion complications21

CHAPTER III: FINDINGS23

Advantages of CT & MRI25

Disadvantages of CT & MRI25

CHAPTER IV: DISCUSSION27

CHAPTER V: CONCLUSION31

REFERENCES35

Chapter I: Introduction

Background

Central venous lines are commonly used in the care of patients who need frequent or long-term venous access. Lines inserted in the upper body are ideally placed with the tip in the superior vena cava (SVC) or the proximal right atrium. The position often is checked with chest radiography. Many mal-positions are obvious on the frontal chest radiograph, but it can be difficult to identify azygos mal-positions on the frontal image alone. For that reason, some authors have recommended routine use of lateral views to evaluate central venous line ...