Lung Ultrasonography to Detect Pneumothorax after Insertion of Central Venous Line – A pilot study

Abstract

Abstract Background Central venous catheterization is a common and sometimes lifesaving procedure. Most patients undergoing cytostatic treatment usually receive one, as well as most patients in intensive care. The most common veins cannulated are the subclavian and the internal jugular veins. One of the major mechanical complications is pneumothorax. The risk of pneumothorax is relatively low, at 1.5%. However, a pneumothorax can have serious adverse effects and sometimes lead to death in certain patients. After CVC placement, patients usually undergo a chest radiograph to rule out major mechanical complications as well as confirm location of the central venous catheter tip. Recently, lung ultrasound has been more and more used in a clinical setting. Studies have proven lung ultrasound to be more sensitive compared to chest radiograph in ruling out pneumothorax (35). Objective The purpose of this pilot study is to elucidate whether lung ultrasound after CVC insertion is a useful tool for ruling out pneumothorax. Method To understand the mechanics and theory surrounding lung ultrasound, a review of the literature was performed. I also attended a lung ultrasound seminar. An experienced physician instructed me in the handling of the ultrasound machine. I examined patients at two wards at Sahlgrenska Universitetssjukhus where central venous catheters are commonly placed. The lung ultrasound exam was performed after placement of the CVC, an improvised screening protocol was used during lung ultrasound examination. Results In total, 155 patients were examined with lung ultrasound. 56 at ward 22 and 99 at preoperative ward 4. There were nine patients with positive findings on lung ultrasound. Out of these, seven pneumothoraces were confirmed by chest x-ray. In two patients, the pneumothorax is believed to be caused by the CVC insertion. Sensitivity was 1 and specificity 0.98. When comparing lung ultrasound with chest radiograph, lung ultrasound proved non-inferiority in this pilot study. Conclusion Lung ultrasound is a fast and easy to use tool and may be used to rule out pneumothorax after CVC insertion.