"Rapid Atrial Swirl Sign": A Better Tool Than the Landmark Technique for Ensuring Correct Depth of Insertion of Central Venous Catheters

• Published in: Curēus (Palo Alto, CA) CA), 2024-07, Vol.16 (7), p.e65211
• Main Authors: Kairidibo, Pandey, Arun Raj, Dwivedi, Vandana, Prakash, Shashi, Rath, Amrita, Reena, Dwivedi, Kanak, Pandey, Ritesh
• Format: Article
• Language: English
• Subjects: Accuracy; Catheters; Coronary vessels; Ultrasonic imaging; Venous access
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.65211

Central venous catheters (CVCs) are widely used in the management and resuscitation of critically ill patients in emergency departments and intensive care units. Correct depth of insertion of the CVC line is important to ensure uninterrupted flow, avoid complications, and monitor central venous pressure. Transthoracic echocardiography, with contrast enhancement, has been proposed as an alternative to chest X-ray in detecting central venous line positioning with high accuracy. Nevertheless, this method is not widely used due to some previous conflicting results and the cumbersomeness of the procedure. After approval by the Institutional Ethics Committee, this prospective observational study was carried out in patients for whom a central venous line was warranted. The study was conducted in the Intensive Care Unit of a tertiary care hospital among 150 adult patients to compare the "Rapid Atrial Swirl Sign" (RASS) technique by transthoracic echocardiography and the landmark-based technique for ensuring accurate depth of central venous line placement. In this study, we found that the mean depth of insertion of the CVC for the Echocardiography RASS group (E) was 12.84 cm, while for the Landmark technique group (L), it was 12.02 cm. There was a significant difference between these groups, with a p-value of