INTRODUCTION: It has been shown that general intensive care nurses are able to perform an examination of the deep venous system of the lower extremities for the diagnosis of proximal deep vein thrombosis (DVT) using a compression ultrasound test with a high degree of reliability. (Skulec et al. in Eur J Intern Med 76:130-131, 2020) Another challenge for the use of vascular point-of-care ultrasound in intensive care is the diagnosis of central venous catheter-related thrombosis. It is a common problem that is often underdiagnosed. Due to the simplicity of the examination and the possible link with nursing care of inserted central venous catheters, this may be another potential diagnostic competency for critical care nurses. METHODOLOGY: Before the start of the study, each nurse participating in the study completed a two-hour training in duplex ultrasonography and examined 5 patients under supervision. Then patients in the intensive care unit (ICU) included in the study, underwent a duplex ultrasound performed by a nurse. Within 24 h, the examination was repeated by the ICU doctor. In the case of catheter insertion into the internal jugular vein (VJI) or the subclavian vein (VSC), the jugular vein, subclavian vein, and axillary vein (VA) were examined bilaterally. When the catheter was inserted into the femoral vein (VF), the patients were subjected to a duplex ultrasound of the femoral vein and the popliteal vein (VP) of both lower limbs. The examination results of each patient were blinded until both tests were performed. Calculations were used to evaluate the reliability of the test. RESULT: A total of 160 patients aged 62.9 ± 12.3 years were included. In our sample, the prevalence of CRT was found to be 41%. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of examinations performed by general intensive care nurses were 90.8%, 97.1%, 91.8%, 96.8%, and 95.5%, respectively. CONCLUSION: The results of our study suggest that general ICU nurses are able to perform inpatient CRT duplex ultrasound with excellent specificity but only moderate sensitivity after a short, predefined training.

Department of Anesthesia Pain Management and Perioperative Medicine Dalhousie University Halifax NS B3H 4R2 Canada

Department of Anesthesiology and Intensive Care Faculty of Medicine in Hradec Kralove Charles University University Hospital Hradec Kralove Sokolska 581 500 05 Hradec Kralove Czech Republic

Department of Anesthesiology Perioperative Medicine and Intensive Care J E Purkinje University Masaryk Hospital Usti Nad Labem Socialni pece 3316 12A 400 11 Usti nad Labem Czech Republic

Department of Research and Development Faculty of Medicine in Hradec Kralove Charles University Prague University Hospital Hradec Kralove Sokolska 581 500 05 Hradec Kralove Czech Republic

Emergency Medical Service of the Central Bohemian Region Vancurova 1544 272 01 Kladno Czech Republic

Emergency Medical Service of the Usti Region Socialni pece 799 7a 400 11 Usti nad Labem Czech Republic

Faculty of Health Studies J E Purkinje University Socialni pece 3316 12A 400 11 Usti nad Labem Czech Republic

Faculty of Medicine in Hradec Kralove Charles University University Hospital Hradec Kralove Simkova 870 500 03 Hradec Kralove Czech Republic

Zobrazit více v PubMed

Centor RM (1992) Estimating confidence intervals of likelihood ratios. Med Decis Mak 12:229–232. 10.1177/0272989X9201200309 PubMed

Citla Sridhar D, Abou-Ismail MY, Ahuja SP (2020) Central venous catheter-related thrombosis in children and adults. Thromb Res 187:103–112. 10.1016/j.thromres.2020.01.017 PubMed

Di Nisio M, Van Sluis GL, Bossuyt PMM, Büller HR, Porreca E, Rutjes AWS (2010) Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: a systematic review. J Thromb Haemost 8(4):684–692. 10.1111/j.1538-7836.2010.03771.x PubMed

Ferreira FL, Bota DP, Bross A et al (2001) Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 286(14):1754–1758 PubMed

Geerts W (2014) Central venous catheter–related thrombosis. Am Soc Hematol 1:306–311. 10.1182/asheducation-2014.1.306 PubMed

Lowell JA, Bothe A (1995) Central venous catheter related thrombosis. Surg Oncol Clin N Am 4(3):479–492 PubMed

Marin A, Bull L, Kinzie M, Andresen M (2021) Central catheter-associated deep vein thrombosis in cancer: clinical course, prophylaxis, treatment. BMJ Support Palliat Care 11(4):371–380. 10.1136/bmjspcare-2019-002106 PubMed PMC

Mercaldo ND, Lau KF, Zhou XH (2007) Confidence intervals for predictive values with an emphasis to case–control studies. Stat Med 26(10):2170–2183. 10.1002/sim.2677 PubMed

Mumoli N, Vitale J, Cocciolo M, Cei M, Brondi B, Basile V et al (2014) Accuracy of nurse- performed compression ultrasonography in the diagnosis of proximal symptomatic deep vein thrombosis: a prospective cohort study. J Thromb Haemost 12:430–435 PubMed

Pomero F, Dentali F, Borretta V, Bonzini M, Melchio R, Douketis JD, Fenoglio LM (2013) Accuracy of emergency physician–performed ultrasonography in the diagnosis of deep-vein thrombosis. A systematic review and meta-analysis. Thromb Haemost 109:137–145. 10.1160/TH12-07-0473 PubMed

Skulec R, Kohlova A, Miksova L, Cerny V (2020) The reliability of ultrasound compression test performed by general ICU nurses in the critically ill patients: a preliminary prospective clinical study. Eur J Intern Med 76:130–131. 10.1016/j.ejim.2020.03.007 PubMed

Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, Carlet J (1998) Central vein catheter-related thrombosis in intensive care patients: Incidence, risks factors, and relationship with catheter-related sepsis. Chest 114(1):207–213. 10.1378/chest.114.1.207 PubMed

Vincent JL, de Mendonça A, Cantraine F et al (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26(11):1793–1800 PubMed

Wang J, Wang L, Shang H, Yang X, Guo S, Wang Y, Cui C (2020) Jugular venous catheter-associated thrombosis and fatal pulmonary embolism: a case report. Medicine (Baltimore) 99(26):e20873. 10.1097/MD.0000000000020873 PubMed PMC

Yacopetti N (2008) Central venous catheter-related thrombosis: a systematic review. J Infus Nurs 31(4):241–248. 10.1097/01.NAN.0000326833.59655.9e PubMed

Zochios V, Umar I, Simpson N, Jones N (2014) Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access 15(5):329–337. 10.5301/jva.5000239 PubMed