Accuracy of clinical tests to verify the proper placement of central venous catheter in the Emergency Room.

Exactitud de pruebas clínicas para verificar la adecuada colocación del catéter venoso central en Urgencias.

• Jorge Ayón-Aguilar Instituto Mexicano del Seguro Social
• Norberto Martínez-Luna Instituto Mexicano del Seguro Social
• Fernando Fernández-Lucas Instituto Mexicano del Seguro Social
• Socorro Méndez-Martínez Instituto Mexicano del Seguro Social
• Patricia Seefoó-Jarquín Instituto Mexicano del Seguro Social

DOI: https://doi.org/10.22209/IC.v62n3a03

Keywords: central venous catheter, chest X-ray, ultrasound

Abstract

The utility of the central venous catheter (CVC) depends on its proper placement; chest X-ray is the gold standard for corroborating it. We studied five clinical tests as useful tools for determining the CVC placement. The objective of the present study was to determine the sensitivity, specificity and predictive values from five clinical tests to verify the proper CVC placement, in patients admitted to the ER in need of a CVC procedure. Five clinical tests were performed: determination of arrhythmias (Ar), venous return (VR), central venous pressure oscillation (CVPO), external measurement (EM) and central venous blood gases (CVBG); the position of the catheter was corroborated with chest X-ray. Of the 128 patients who were included, 97% had adequate placement of the CVC on chest X-ray. The results of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the tests were: Ar: 59.6%, 50%, 93.7% and 3.8%; VR: 100%, 0%, 96.8% and 0%; CVPO: 99.1%, 25%, 97.6% and 50%; EM: 100%, 0%, 96.8% and 0%; CVBG: 96.7%, 0%, 96.7% y 0%, respectively. We conclude that due to their high sensitivity and positive predictive values, if the CVPO, Ar and VR clinical tests are positive, they could replace the need for an immediate chest X-ray and not delay the use of the CVC, as long as no early complications in its placement are suspected.

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