Evidence map›Paper›PMID 34124497›Full record

ArticleAEM education and training2021

Point-of-care Ultrasound-guided Central Venous Catheter Confirmation in Ultrasound Nonexperts.

Enyo A Ablordeppey, Anne M Drewry, Adam L Anderson, Diego Casali, Laura A Wallace, Deborah S Kane, LinLin Tian, Stacey L House, Brian M Fuller, Richard T Griffey and 1 more

Open access · greenAbstract read
In one paragraph

Article in AEM education and training, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
0.8field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 8 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Enyo A AblordeppeyDepartment of Anesthesiology Washington University School of Medicine St. Louis MO USA.ORCID https://orcid.org/0000-0003-4351-6720
Anne M DrewryDepartment of Anesthesiology Washington University School of Medicine St. Louis MO USA.
Adam L Andersonthe Department of Internal Medicine Washington University School of Medicine St. Louis MO USA.
Diego Casaliand the Department of Surgery Washington University School of Medicine St. Louis MO USA.
Laura A Wallacethe Department of Emergency Medicine Washington University School of Medicine St. Louis MO USA.
Deborah S Kanethe Department of Emergency Medicine Washington University School of Medicine St. Louis MO USA.
LinLin Tianthe Department of Emergency Medicine Washington University School of Medicine St. Louis MO USA.
Stacey L Housethe Department of Emergency Medicine Washington University School of Medicine St. Louis MO USA.
Brian M FullerDepartment of Anesthesiology Washington University School of Medicine St. Louis MO USA.
Richard T Griffeythe Department of Emergency Medicine Washington University School of Medicine St. Louis MO USA.ORCID https://orcid.org/0000-0002-6279-7380
Daniel L Theodorothe Department of Emergency Medicine Washington University School of Medicine St. Louis MO USA.ORCID https://orcid.org/0000-0001-6851-4962
Washington University in St. Louis · USCedars-Sinai Medical Center · US

Funding

WU INSTITUTE OF CLINICAL AND TRANSLATIONAL SCIENCESUL1TR002345 · NCATS · WASHINGTON UNIVERSITY · PI William G. Powderly · 2017 to 2026
$97.8M
Washington University K12 Program in T4 Implementation ResearchK12HL137942 · NHLBI · WASHINGTON UNIVERSITY · PI DAVILA-ROMAN, VICTOR G. · 2017 to 2021
$3.1M
NCATS NIH HHS UL1 TR002345NHLBI NIH HHS K12 HL137942
6 · The paper itself

Abstract

objectiveEmerging evidence suggests that chest radiography (CXR) following central venous catheter (CVC) placement is unnecessary when point-of-care ultrasound (POCUS) is used to confirm catheter position and exclude pneumothorax. However, few providers have adopted this practice, and it is unknown what contributing factors may play a role in this lack of adoption, such as ultrasound experience. The objective of this study was to evaluate the diagnostic accuracy of POCUS to confirm CVC position and exclude a pneumothorax after brief education and training of nonexperts.

methodsWe performed a prospective cohort study in a single academic medical center to determine the diagnostic characteristics of a POCUS-guided CVC confirmation protocol after brief training performed by POCUS nonexperts. POCUS nonexperts (emergency medicine senior residents and critical care fellows) independently performed a POCUS-guided CVC confirmation protocol after a 30-minute didactic training. The primary outcome was the diagnostic accuracy of the POCUS-guided CVC confirmation protocol for malposition and pneumothorax detection. Secondary outcomes were efficiency and feasibility of adequate image acquisition, adjudicated by POCUS experts.

resultsTwenty-six POCUS nonexperts collected data on 190 patients in the final analysis. There were five (2.5%) CVC malpositions and six (3%) pneumothoraxes on CXR. The positive likelihood ratios of POCUS for malposition detection and pneumothorax were 12.33 (95% confidence interval [CI] = 3.26 to 46.69) and 3.41 (95% CI = 0.51 to 22.76), respectively. The accuracy of POCUS for pneumothorax detection compared to CXR was 0.93 (95% CI = 0.88 to 0.96) and the sensitivity was 0.17 (95% CI = 0.00 to 0.64). The median (interquartile range) time for CVC confirmation was lower for POCUS (9 minutes [8.5-9.5 minutes]) compared to CXR (29 minutes [1-269 minutes]; Mann-Whitney U, p < 0.01). Adequate protocol image acquisition was achieved in 76% of the patients.

conclusionThirty-minute training of POCUS in nonexperts demonstrates adequate diagnostic accuracy, efficiency, and feasibility of POCUS-guided CVC position confirmation, but not exclusion of pneumothorax.

Identifiers

PMID34124497
PMCPMC8173448
OpenAlexW3088495525

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.