PT  - JOURNAL ARTICLE
AU  - Peter Korsten
AU  - Eirini Mavropoulou
AU  - Gerhard A. Müller
AU  - Daniel Patschan
TI  - The “rapid atrial swirl sign“ for evaluating central venous catheter tip position is appropriate and time-saving in critical care environments
AID  - 10.1183/13993003.congress-2015.PA2150
DP  - 2015 Sep 01
TA  - European Respiratory Journal
PG  - PA2150
VI  - 46
IP  - suppl 59
4099  - http://erj.ersjournals.com/content/46/suppl_59/PA2150.short
4100  - http://erj.ersjournals.com/content/46/suppl_59/PA2150.full
SO  - Eur Respir J2015 Sep 01; 46
AB  - Background: The standard procedure to assess for appropriate central venous catheter (CVC) placement in acute care environments is chest radiography (CXR). There are few studies examining the use of bedside echocardiography (ECO) comparing CXR using the “rapid atrial swirl sign” (RASS). The RASS consists of a bright flush after injecting 10 mL of normal saline observed within the right atrium.Aims and objective: The primary goal of this prospective study is to find out whether ECO can equally be used compared to CXR when assessing for correct CVC placement.Methods: Residents in the Intensive Care (ICU) or Intermediate Care Unit (IMC) were assigned to evaluate CVC placement using ECO. After CVC placement, CXR was ordered and time until CXR recorded. Immediately after CVC placement, ECO was performed and the duration of the examination measured. Placement was appropriate when flush was present or CXR showed a tip position ±3 cm in relation to the carina.Results: We compared the first 21 (of 100) consecutive CVC placements. There were 4 misplaced catheters identified by CXR and ECO. 2 correctly placed catheters as judged by CXR had a negative RASS. Sensitivity and specificity of ECO for appropriate tip position were 89% and 100%.Median time of ECO was 5 versus 40 minutes for CXR (p<0,001). When different groups of residents (2nd, 3rd and 4th year) were compared, there was no difference in the time needed to perform the exam (5, 4 and 5 minutes, resp.; p=0,767).Conclusions: Bedside echocardiography is non-inferior to CXR for the evaluation of central venous catheter placement. It is faster and can be easily performed by ICU residents.