Assessing MMode Echo Time-to-Turbulance to confirm CVC tip position

• Research type

  Research Study

• Full title

  Assessing validity of M-Mode Time-to-Turbulence “T2T” Echo use to confirm CVC tip position

• IRAS ID

  205998

• Contact name

  Mohammed Dessoky

• Contact email

  mohammed.deesoky@stft.nhs.uk

• Sponsor organisation

  STFT

• Duration of Study in the UK

  0 years, 7 months, 31 days

• Research summary

  Common sites of insertion of the Centra Venous Catheter (CVC) are internal jugular and subclavian vein. It is obligatory to confirm correct positioning of the CVC in the superior vena cava (SVC) at or before the junction with the right atrium before use. The incorrectly positioned catheter can lead to significant complications including arrhythmias and haemothorax. The most common method used to confirm correct CVC tip positioning is the chest x-ray (CXR). Frequent use of CXR in intensive care leads to repeated exposure to radiation and has implications for use of resources and cost.
  Ultrasound is currently not routinely used to confirm the correct position of the CVC tip.
  Some studies focused on the direct US identification of the distal CVC tip near to or within the right atrium or the aberrant placement within an IJ or SC vein. Others indirectly identified venous insertion and distal CVC tip location near the right atrium by the rapid entry of turbulent flow into the right atrium after agitated saline or rapid saline flush of the distal CVC port. Delayed and weak turbulence suggests aberrant venous placement whereas complete lack of turbulence is concerning for arterial CVC placement.The previous studies used a 2D substernal view to detect the turbulence in the right atrium. The time measurement had no set On and Set Off on the machine , which makes it hard to review or record. A great advantage of M-mode echocardiography is its high temporal resolution which enables simple and accurate measurement of the time and distance of any structure movement. We are using M-Mode to measure a temporal change which makes it a more accurate measurement. The trigger time and the end point , i.e turbulence, can be recorded , reviewed and audited.

• REC name

  North East - Newcastle & North Tyneside 2 Research Ethics Committee

• REC reference

  16/NE/0332

• Date of REC Opinion

  31 Oct 2016

• REC opinion

  Favourable Opinion