Application Value Of Transthoracic Echocardiography In Predicting The Depth Of Central Venous Catheterization

Objective:Transthoracic Echocardiography(TTE)was used to predict the depth of catheter implantation before central vein catheterization and to evaluate the position of the catheter tip postoperatively.By comparing the consistency and difference between the implantation depth predicted by ultrasonic and surface localization methods and the ideal implantation depth,the feasibility and accuracy of the prediction of catheter implantation depth by ultrasonic localization method were evaluated.On this basis,the correlation between patients’basic clinical data and catheterization depth was explored to provide a new method for determining the catheterization depth of central vein.Methods:75 Hemodialysis(HD)patients who had ever had Right internal jugular vein(RIJV)hemodialysis in Affiliated Hospital of Chengde Medical College from January 2020 to September 2022 were selected as the subjects of observation.Data of age,sex,height and weight were collected by Picture archiving and communication systems(PACS).The size of the patient’s upper and lower thoracic diameters,right and left diameters,and anterior and posterior diameters were measured before central venous cannulation,and the ratio of anterior and posterior diameters to right and left diameters was calculated.Two different methods of predicting catheter implantation depth,ultrasound localization and body surface localization,were used in all included patients.The length from the puncture point to the ultrasound localization point was measured as the ultrasound localization implantation depth;the length between the puncture point and the lower edge of the third sternal rib joint was measured as the body surface localization implantation depth.The actual operation was performed according to the implantation depth of body surface positioning.Before withdrawal of the guidewire,TTE is applied to assess the tip position.If the position was not appropriate,it was adjusted to the appropriate position before withdrawal of the guidewire and suturing.After catheterization,all patients took X-ray chest films,and the ideal implantation depth was calculated by measuring the distance between the level of the carina and the tip of the central venous catheter.At the same time,the position of the catheter tip was observed on the X-ray chest film.All values were measured three times and averaged.Results:1.The mean value of the implantation depth for ultrasound localization was(14.66±1.60)cm,the mean value of the implantation depth for body surface localization was(14.99±1.82)cm,and the mean value of the ideal implantation depth was(14.54±1.67)cm.2.The agreement between the ultrasonically localized implantation depth and the ideal implantation depth was high(ICC=0.796,P<0.001).The agreement between the implantation depth for body surface localization and the ideal implantation depth was better(ICC=0.517,P<0.001).The agreement between the ultrasound-localized implantation depth and the ideal implantation depth was higher.3.There was no statistically significant difference between the implantation depth of ultrasound localization and the ideal implantation depth(P=0.302,P>0.05).There is a statistically significant difference between the implantation depth of body surface localization and the ideal implantation depth(P<0.05),and the implantation depth of body surface localization is deeper than the ideal implantation depth.There was a statistically significant difference between the implantation depth of ultrasound localization and that of body surface localization(P<0.05),and the implantation depth of body surface localization was deeper than that of ultrasound localization.4.The tune-up rate was 16%for surface positioning.The tip arrival rate of ultrasonic evaluation was 100%.5.Correlation analysis showed that height,upper and lower thoracic diameters and anterior and posterior/left and right diameters were significantly and positively correlated with the ultrasonographic implantation depth(r=0.458,0.516,0.237,P<0.05),with the best correlation between upper and lower thoracic diameters and the ultrasonographic implantation depth.6.Multiple linear regression analysis yielded a regression equation based on both height and upper and lower thoracic diameters:ultrasonically localized implantation depth(cm)=0.057×height+0.249×upper and lower thoracic diameters-0.178(R=0.576,R~2=0.313,F=17.829,P<0.05).Conclusions:1.The implantation depth of ultrasound localization is closer to the ideal implantation depth than that of surface localization,and the accuracy is higher.It is feasible and accurate to use ultrasound localization method to predict the implantation depth of catheter,which can be used as a new method for clinical determination of catheter implantation depth in the future.2.Transthoracic echocardiography can predict the depth of catheter implantation before catheterization,and evaluate the position of the catheter tip before the guide wire is withdrawn.Abnormal position of the tip can be detected and adjusted in time,reducing the damage to patients caused by secondary catheter removal and adjustment after suture.3.In this study,there is a correlation between height,thoracic vertical diameter and anterior-posterior diameter/left and right diameter and the implantation depth determined by ultrasound,which can provide a reference for the prediction of implantation depth.4.The formula based on height and upper and lower thoracic diameters obtained in this study can provide reference for clinical prediction of central venous catheterization depth.