Validez de las pruebas clínicas para determinar posición del catéter venoso central

Martínez-Flores, Favio; Márquez-González, Horacio; Márquez-Flores, Horacio; Rodríguez-Reyes, Esperanza Rosalba; De Lourdes Guerrero-Almeida, María
November 2009
Revista Medica del IMSS;nov/dic2009, Vol. 47 Issue 6, p665
Academic Journal
Background: chest x-ray (Rx) is the standard test to assess correct placement of a central venous catheter (CVC). Our objective was to validate the use of four clinical measures (CMs) to assess the proper placement of the line. Methods: during a period of eight month, at the Intensive Care Unit a prospective study was done. A chest Rx was always obtained to assess the position of the catheter. The CMs were: venous return; waveform of the central venous pressure (CVP); arrhythmias while advancing the guide wire and the difference between planned length in cm to be introduced and the length of the catheter introduced. Results: for each parameter alone the sensitivity and specificity found were: for venous return 97% and 22%, for CVP waveform changes 86% and 40%, for arrhythmias 97% and 60%, for difference between planned and real length introduced into the patient 97% and 50% respectively. According to chest x-ray, 78% of the catheters were located at a central position. Using the four CMs, we obtained 86% sensitivity and 90% specificity of the placement of the CVC. Conclusions: the use of each parameter alone is highly sensitive but poorly specific.


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