Supradiaphragmatic central venous catheter tip malposition detection using nonagitated solutions: A feasibility and comparative analysis

Abstract Background Contrast‐enhanced ultrasound (CEUS) using normal saline (NS) is an alternative to chest radiograph (CXR) to confirm central venous catheter (CVC) tip position during emergency. We aim to assess the feasibility and compare the efficacy of Dextrose 50% (D50%) and NS in detecting CVC malposition against CXR. Method This is a cross‐sectional single center study involving hospitalized patients. We used D50% and NS as contrast agents by identifying the rapid atrial swirl sign (RASS) features. RASS was assessed by parasternal long axis (RVI PLAX), subcostal, or apical 4‐chamber (A4c) view. We compared the agreement, sensitivity, and specificity of each solutions with CXR. Results Seven CVC tip malpositions were confirmed by CXR (four within the right atrium [RA], one in the right brachiocephalic vein, 1 in the inferior vena cava, and 1 right CVC in the left brachiocephalic vein). Only one (in the RA) of the malposition was detected by both contrast. There was poor agreement between D50% ( k = 0.049) and NS ( k = 0.078) with CXR. The sensitivity for each contrast and the combination of both to detect CVC malposition were almost similar (14.3% vs. 14%). The specificity of D50% and NS in detecting CVC malposition was 91% and 93%, respectively. There was a fair agreement when both solutions were compared to each other ( k = 0.321). No arterial tip malposition occurred. Conclusion D50% and NS are equivalent to confirm CVC position but has poor agreement as compared to CXR. As such, CEUS cannot replace CXR but is useful as an adjunct for preliminary confirmation of CVC position in emergency setting.