Clinical Tests to Determine the Correct Position of Central Venous Catheter in Overweight Patients in Critically Ill Condition

Abstract

Objective:  To demonstrate the utility of clinical test to determine the correct placement of the CVC in overweight patients in critical condition. Methods: Cross-sectional Study carried out in the Intensive Care Unit of the High Speciality Medical Unit of Traumatology and Orthopedics from Mexican Social Security Institute during 2014. The variables were age, sex, Body Mass Index and clinical diagnostic test. The placement of the catheter was done percutaneously, once the catheter was placed, clinical tests for determining the correct placement were done, verifying cardiac arrhythmias, test of venous return, measurement of Central Venous Catheter pressure and external length of the catheter. The statistics used was descriptive. Results: Thirty-one patients were included. To all the patients clinical diagnosis tests were performed to verify the correct placement of the Central Venous Catheter (58%). The average Body Mass Index was 26. Of the catheters placed, 29.03% were central and 70.96% were misplaced, according to the chest x-ray. The arrhythmias were presented in 9.67%, with a specificity of 90%, and negative predictive value of 90%. The variations in central venous pressure were presented in 32.25% patients; the sensitivity was 20%, the specificity and negative predictive value were 60% respectively. Conclusion: We found low sensitivity and good specificity for these clinical tests.