Intensive Care Unit Patients However, in another study, contrast-enhanced US detected 11 of the 16 true catheter malpositionings. Contrast- enhanced US showed 2 false right atrium misplacements and 5 falsely correct CVC positions. They concluded that contrast-enhanced US is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored [50]. A systematic review and meta-analysis to examine the accuracy of bedside US for confirmation of CVC position and exclusion of pneumothorax compared with chest radiography concluded that LUS is faster than radiography at identifying pneumothorax after CVC insertion. When a CVC malposition exists, bedside US will identify 4 out of every 5 earlier than chest radiography [51]. Swan-Ganz Catheter There is insufficient data evaluating the placement of pulmonary artery catheter. US may be used to guide insertion of a Swan-Ganz catheter. Nasogastric Tubes A pilot study confirmed the high sensitivity of US in the correct positioning of gastric tube in the adult ICU patient. The US examination seems to be easy and faster when performed by an intensivist with a sonographic training of only 40 hours [52]. A study designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and US as physical examination methods to verify nasogastric tube placement in emergency department patients with low consciousness in 47 patients concluded that US is useful for confirming the results of auscultation after nasogastric tube insertion among patients with low consciousness. When US findings suggest that the nasogastric tube placement is not gastric, additional chest radiographs should be performed [53]. Variant 5: Intensive care unit patient. Post chest tube or mediastinal tube removal. Initial imaging.
Intensive Care Unit Patients. Intensive Care Unit Patients However, in another study, contrast-enhanced US detected 11 of the 16 true catheter malpositionings. Contrast- enhanced US showed 2 false right atrium misplacements and 5 falsely correct CVC positions. They concluded that contrast-enhanced US is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored [50]. A systematic review and meta-analysis to examine the accuracy of bedside US for confirmation of CVC position and exclusion of pneumothorax compared with chest radiography concluded that LUS is faster than radiography at identifying pneumothorax after CVC insertion. When a CVC malposition exists, bedside US will identify 4 out of every 5 earlier than chest radiography [51]. Swan-Ganz Catheter There is insufficient data evaluating the placement of pulmonary artery catheter. US may be used to guide insertion of a Swan-Ganz catheter. Nasogastric Tubes A pilot study confirmed the high sensitivity of US in the correct positioning of gastric tube in the adult ICU patient. The US examination seems to be easy and faster when performed by an intensivist with a sonographic training of only 40 hours [52]. A study designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and US as physical examination methods to verify nasogastric tube placement in emergency department patients with low consciousness in 47 patients concluded that US is useful for confirming the results of auscultation after nasogastric tube insertion among patients with low consciousness. When US findings suggest that the nasogastric tube placement is not gastric, additional chest radiographs should be performed [53]. Variant 5: Intensive care unit patient. Post chest tube or mediastinal tube removal. Initial imaging.