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The author responds
American Journal of Emergency Medicine xxx (2014) xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
The author responds To the Editor,
We are grateful for the comments of Vezzali et al, [1] and we agree with them that a combined method of B-mode and contrast enhanced ultrasonography (CEUS) would help identify the correct position of the Central venous line (CVL) tip. In our study, we checked in B-mode the Seldinger during canulation and before dilatation of the vessel (to avoid complication), and we believe it is also important to check omo- and controlateral neck veins after CVL insertion to identify intravascular malpositioning. Regarding ultrasound evaluation of the tip position of the CVL in the intrathoracic vessels using B-mode, we can see the tip in the neck veins and only few centimeters before the entrance of superior vena cava (SVC) in right atrium (this means that the tip might be anywhere distal the brachiocephalic vein); in our study, CEUS could not differentiate the malpositioning of CVL in brachiocefalic vein as the delay of appearance compared with correct positioning in SVC is not detectable with visual extimation time of bubble appearance in right atrium (RA).
B-mode could be useful to visualize the tip in the RA cavity. A combination of B-mode and CEUS is feasible and not really time consuming, and we believe it must be used to check intravascular malpositioning in the neck veins and to confirm correct tip positioning with the limitation that we will not be able to visualize the tip distally to the brachiocephalic vein until the entrance of SVC into the atrial vein. Francesca Cortellaro MD Unità Operativa di Pronto Soccorso e Medicina D’urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.02.001 Reference [1] Vezzani A, Brusasco C, Corradi F. Contrast-enhanced ultrasound to determine correct central venous catheter position. Am J Emerg Med 2014 Feb 4. http://dx.doi.org/ 10.1016/j.ajem.2014.01.033. pii: S0735-6757(14)00063-1. [Epub ahead of print].
0735-6757/© 2014 Published by Elsevier Inc. All rights reserved.
Please cite this article as: Cortellaro F, The author responds, Am J Emerg Med (2014), http://dx.doi.org/10.1016/j.ajem.2014.02.001
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
The author responds To the Editor,
We are grateful for the comments of Vezzali et al, [1] and we agree with them that a combined method of B-mode and contrast enhanced ultrasonography (CEUS) would help identify the correct position of the Central venous line (CVL) tip. In our study, we checked in B-mode the Seldinger during canulation and before dilatation of the vessel (to avoid complication), and we believe it is also important to check omo- and controlateral neck veins after CVL insertion to identify intravascular malpositioning. Regarding ultrasound evaluation of the tip position of the CVL in the intrathoracic vessels using B-mode, we can see the tip in the neck veins and only few centimeters before the entrance of superior vena cava (SVC) in right atrium (this means that the tip might be anywhere distal the brachiocephalic vein); in our study, CEUS could not differentiate the malpositioning of CVL in brachiocefalic vein as the delay of appearance compared with correct positioning in SVC is not detectable with visual extimation time of bubble appearance in right atrium (RA).
B-mode could be useful to visualize the tip in the RA cavity. A combination of B-mode and CEUS is feasible and not really time consuming, and we believe it must be used to check intravascular malpositioning in the neck veins and to confirm correct tip positioning with the limitation that we will not be able to visualize the tip distally to the brachiocephalic vein until the entrance of SVC into the atrial vein. Francesca Cortellaro MD Unità Operativa di Pronto Soccorso e Medicina D’urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.02.001 Reference [1] Vezzani A, Brusasco C, Corradi F. Contrast-enhanced ultrasound to determine correct central venous catheter position. Am J Emerg Med 2014 Feb 4. http://dx.doi.org/ 10.1016/j.ajem.2014.01.033. pii: S0735-6757(14)00063-1. [Epub ahead of print].
0735-6757/© 2014 Published by Elsevier Inc. All rights reserved.
Please cite this article as: Cortellaro F, The author responds, Am J Emerg Med (2014), http://dx.doi.org/10.1016/j.ajem.2014.02.001