Literature Summaries - Simplified Point-Of-Care Ultrasound Protocol To Confirm Central Venous Catheter Placement: A Prospective Study & Usage Of Emergency Ultrasound In Emergency Departments of Community Hospitals in Arizona
Date: 7 February 2017
Simplified Point-Of-Care Ultrasound Protocol To Confirm Central Venous Catheter Placement: A Prospective Study
In this study US was used to confirm the placement of CVC (Central Venous Catheter) and compared with CXR (Chest X-ray).
To confirm CVC placement 5 cc of normal saline was injected through line and turbulent flow in right atrium was visualized. Also, CXR was obtained for all patients.
87 patients were enrolled to study. Sensitivity and spesifity for US were 86.8% (Cl 95% 77.1%-93.5%) and 100% (Cl95% 15.8%-100%) respectively.
Only 2 malposition were detected and both were confirmed truely with US.
Second outcome of the study was time elapsed to confirm CVC placement. Mean time for confirmation with US and CXR were 27.6 minute and 37.6 minute respectively. CXR delayed 10 minutes on average (p=0.07).
Authors determined that they simplified the US tecnique for CVC placement confirmation. There are some studies recommend to use contrast for detection of catheter placement, however within this tecnique there is no need for extra material. Also other studies suggest to confirn CVC placement with several views, contributors of this study mention that only one view is adequate.
Nevertheless authors stated that the number of participants of the study was inadequate. Especially malpositioned catheter count was too low in false positive results. As a result further studies will enlighten the superioriority of US than CXR to confim CVC placement.
Usage Of Emergency Ultrasound In Emergency Departments of Community Hospitals in Arizona
In the manuscript of Amini R and colleagues, published in Journal of Ultrasound Medicine in February 2017 (J Ultrasound Med. 2017 Feb 2. doi: 10.7863/ultra.16.05064.) studied a questionnaire in the point-of-care US.
With this cross-sectional study, authors planned to assess the current practices and potential barriers against in using of point-of-care US in nonacademic EDs.
An online questionnaire was sent to a total of 70 nonacademic EDs in Arizona. 58 of them completed the survey (83% ).
The three most common fields of US usage were found in sonography for trauma, cardiac US and US assisted in line placement.
At 75 % of EDs, noone was responsible in review of US examinations and at a ratio of 50% of them, there was not any method used to archieve of images.
83% of EDs think that ACEP Ultrasound Acreditation Program will be hellpful for emergency physicians.
We can talk about in this subject that our country has similarities. EDs can be classified as academic EDs with residency programme or nonacademic state EDs in our country,also.
Unfortunately, it would not be wrong to claim that there are EDs have ultrasonography devices, however they are not used frequently in daily practice due to the insufficient training in POCUS of EPs.
In this respect, it is obvious that the trainings in POCUS of EPs have to be increased.
Volkan Arslan, Attending
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