Rapid perfusion ultrasonography in the assessment of axillary venous catheter tip position: a prospective observational study

BACKGROUND: The study aimed to evaluate the effectiveness of saline rapid perfusion ultrasonography in assessing the catheter tip position in axillary vein cannulation. METHODS: This prospective observational single-center study was conducted in a tertiary Grade A Hospital in China. Seventy adult patients who underwent successful right axillary vein catheterization were included. Patients were consecutively recruited based on eligibility for central venous catheterization via the axillary vein. Exclusion criteria included unsuccessful catheter placement, poor acoustic window for ultrasound, or known anatomical abnormalities. All enrolled participants completed the study. The primary outcome was the accuracy of saline rapid perfusion ultrasonography in determining catheter tip position, assessed through sensitivity, specificity, and agreement (kappa statistic) compared with chest radiography. The secondary outcome was the time required to complete each diagnostic method. RESULTS: The sensitivity and specificity of saline rapid perfusion ultrasonography for determining the axillary vein catheter tip position were100% and 77.8%, respectively. The results were highly consistent with X-ray findings (Kappa = 0.859, P < 0.05). The mean operative time for ultrasonography was 5.6 min (95% CI: 5.3‒6.0), significantly shorter than that of X-ray (70.5 min; 95% CI: 66.3‒74.8). CONCLUSIONS: Physiologic saline rapid perfusion ultrasonography is a highly sensitive and efficient method for assessing axillary vein catheter placement. It offers a faster alternative to X-ray examination, avoiding radiation exposure and contrast-related risks, making it suitable for widespread clinical application.