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Completed

NCT Number: NCT06243445

Echocardiography With Bubble Test for Tip Location of Central Venous Catheters

The goal of this prospective observational study is to test the accuracy of the transthoracic echocardiography with bubble test to verify the location of the tip of the central venous catheter in patients undergoing cardiac surgery procedures. The main questions it aims to answer are:

1. Is there a difference in time elapsed between the injection of a saline solution (echogenic contrast) through a central venous catheter and the visualization of micro bubbles in right atrium ("push to bubbles" time) with transthoracic echocardiography, when the catheter tip is placed in four different positions identified by transesophageal echocardiography? 2. Is there a difference in time for the right atrium to be completely filled by bubbles after saline injection in a central venous catheter with the tip placed in four different positions identified by transesophageal echocardiography? 3. In what percentage of patients the acoustic window is good enough to evaluate "push to bubbles" time? 4. Is there a difference in "push to bubbles" time between different echocardiographic projections? 5. Is the bubbles flow laminar or turbulent in the four different positions? 6. Is there a relation between "push to bubble" time and heart rate, blood pressure, pulmonary artery pressure, central venous pressure and cardiac output measured through a pulmonary artery catheter?

Participants will require simultaneously a central venous catheter and an intraoperative transesophageal echocardiography.

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Key information

Conditions

Cardiac Surgery Patient

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

Gabriella Arlotta

Roma, 00168, Italy

About this study

The placement of central vascular access devices (VADs), with cervical-thoracic or femoral insertion (such as CICC, Central Inserted Central Catheter, and FICC, Femoral Inserted Central Catheter), as well as peripheral insertion (PICC, Peripherally Inserted Central Catheter), is a common procedure for patients admitted to the Intensive Care Unit and for patients undergoing major surgery or prolonged infusion therapy.

To reduce the incidence of complications related to improper positioning of the central venous catheter, the tip should be positioned in the lower part of the superior vena cava or in the upper part of the right atrium near the cavo-atrial junction, identified by the crista terminalis.

Among the methods used to verify the correct tip placement, the intracavitary ECG method is strongly recommended by various international guidelines, and its use has been widely validated in terms of safety, efficacy, and accuracy. However, the intracavitary ECG method, based on the principle that the appearance of a high P-wave indicates the proximity of the tip to the cavo-atrial junction, has limitations when it comes to patients with non-sinus rhythm. Recent studies are validating the use of modified intracavitary ECG in patients with atrial fibrillation, but in other cases where a P-wave is not visible, the method is not applicable.

Various methods for ultrasound-guided placement and confirmation of the final tip position have been developed, also because the chest X-ray performed at the patient's bedside has proven to be a less accurate method due to the lack of definite findings of the cavo-atrial junction.

Transesophageal echocardiography (TEE), while being the method of choice as it allows direct visualization of the cavo-atrial junction and, therefore, the real position of both the guidewire and the tip of the catheter at the end of placement, remains an invasive method that is difficult to perform outside of cardiac operating rooms.

Transthoracic echocardiography may allow for the direct visualization of the tip of the VAD inside the heart chambers or indirectly assessing the tip's position by injecting echogenic contrast. Echogenic contrast refers to a rapid bolus of 5-20 ml of 0.9% saline solution, with or without the addition of 1 ml of air, vigorously shaken to create micro bubbles that can be easily visualized during the echocardiographic exam. The bolus is injected into the VAD once it has been positioned, and the micro bubbles are visualized in the right atrium, using transthoracic echocardiography. In nearly all studies, the VAD is considered in the correct position if the micro bubbles appear in the atrium within 2 seconds of injection ("push to bubble" time); otherwise, it is not considered correctly positioned if the bubbles appear after 2 seconds, but in one study, the adequate time was considered to be less than 500 ms. In almost all echocardiography studies, however, the reference method used to evaluate and confirm the VAD tip position has been chest radiography, which has been proven to be a less accurate method; moreover, literature shows significant variations in the indicative times for the visualization of micro bubbles that suggest incorrect position (range 0.5-2 seconds).

In this context, it could be useful to determine accurately if different "push to bubble" times are indicative for different positions of the VAD tip. For this purpose, the echogenic contrast (10 ml of 0,9% saline solution with the addition of 1 ml of air vigorously shaken to create micro bubbles) will be injected in the distal lumen of a VAD, whose tip is positioned in four different points, identified with using transesophageal echocardiography and the time from the contrast injection to the visualization of the bubbles in right atrium will be recorded using transthoracic echocardiography.

The four positions in which the catheter tip will be placed are: right atrium, cavo-atrial junction (CAJ), at 4 centimeters proximal to the CAJ in superior vena cava and at 8 centimeters to the CAJ. The catheter tip positions in right atrium and at CAJ will be directly evaluated using 2D and 3D transesophageal echocardiography, the other positions will be obtained moving the catheter back 4 and 8 centimeters from the CAJ. The transthoracic echocardiography will be carried out always by the same cardiologist trained in echocardiography unaware of the purpose of the study. The time measurements will be carried out always by the same cardiac anaesthesiologist, trained in echocardiography, unaware of the different catheter tip positions.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • age > 18 years
  • written informed consent from the patient
  • intra-operative need for a central venous catheterization via the supra/infra clavicular right veins (centrally inserted central catheter, CICC)
  • indication to intra-operative Trans Esophageal Ultrasound (TEE) based on American Society of Anesthesiologists (ASA)

Exclusion criteria

  • contraindications to TEE based on American Society of Anesthesiologists (ASA) recommendations (esophageal or gastric diseases or previous surgery)
  • emergency procedures
  • central VAD already placed
  • need for a CICC via supra/infra clavicular left veins
  • need for a femorally inserted central catheter (FICC)
  • need for a peripherally inserted central catheter (PICC)
  • tricuspid valve regurgitation
  • hemodynamic instability/ presence of an intra-aortic ballon pump (IABP)
  • absence of septal atrial defect

Treatment and study plan

Transthoracic echocardiography for central venous catheter tip location

Diagnostic Test

Measure of time between injection of echographic contrast in the distal lumen of a central venous catheter, inserted via supra/infra clavicular right veins, and visualization, using transthoracic echocardiography, of micro bubbles in right atrium with the catheter tip positioned under transesophageal ultrasound control in four different positions: right atrium, cavo-atrial junction (CAJ), at 4 centimeters proximal to CAJ, in superior vena cava and at 8 centimeters proximal to CAJ

Primary outcomes

  1. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 1: right atrium, using subcostal 4-chamber view

    Time frame: Immediately after the induction of anesthesia, placement of transesophageal probe and insertion of a central venous catheter. The video recorded will be analyzed immediately after the end of the procedure

    After the insertion of a central venous catheter in the supraclavicular right area by ultrasound guidance and direct Seldinger technique, under transesophageal ultrasound control, the catheter tip will be placed in right atrium, 2 cm below the CAJ; the echographic contrast will be injected through the proximal end of the catheter connected, via an Arrow-Johans adapter (Teleflex) and a dedicated ECG cable (Teleflex), to the transthoracic ultrasound machine. The video with the micro bubbles injected will be recorded by a cardiologist expert in echocardiography, unaware of the purpose of the study, using a subcostal 4-chamber view. Later a cardiac anesthesiologist, unaware of the purpose of the position of the catheter, will measure the time elapsed between the first positive wave created by the contrast injection on the intracavitary ECG recorded by the transthoracic ultrasound machine and the time in which the bubbles will appear in the right atrium.

  2. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 1: right atrium, using subcostal bicaval view

    Time frame: Immediately after the video recorded with the catheter tip placed in right atrium using subcostal 4-chamber view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed in right atrium using subcostal bicaval view

  3. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 1: right atrium, using apical 4-chamber view

    Time frame: Immediately after the video recorded with the catheter tip placed in right atrium using subcostal bicaval view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed in right atrium using apical 4-chamber view

  4. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 2: cavo-atrial junction (CAJ), using subcostal 4-chamber view

    Time frame: Immediately after the video recorded with the catheter tip placed in right atrium using apical 4-chamber view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at the CAJ, using subcostal 4-chamber view

  5. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 2: cavo-atrial junction (CAJ), using subcostal bicaval view

    Time frame: Immediately after the video recorded with the catheter tip placed at the CAJ using subcostal 4-chamber view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at the CAJ, using subcostal bicaval view

  6. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 2: cavo-atrial junction (CAJ), using apical 4-chamber view

    Time frame: Immediately after the video recorded with the catheter tip placed at the CAJ using subcostal bicaval view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at the CAJ, using apical 4-chamber view

  7. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 3: at 4 centimeters proximal to CAJ in superior vena cava, using subcostal 4-chamber view

    Time frame: Immediately after the video recorded with the catheter tip placed at the CAJ using apical 4-chamber view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at , 4 centimeters proximal to CAJ in superior vena cava, using subcostal 4-chamber view

  8. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 3: at 4 centimeters proximal to CAJ in superior vena cava, using subcostal bicaval view

    Time frame: Immediately after the video recorded with the catheter tip at 4 centimeters proximal to CAJ, in superior vena cava, using subcostal 4-chamber view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at 4 centimeters proximal to CAJ in superior vena cava, using subcostal bicaval view

  9. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 3: at 4 centimeters proximal to CAJ in superior vena cava, using apical 4-chamber view

    Time frame: Immediately after the video recorded with the catheter tip at 4 centimeters proximal to CAJ, in superior vena cava, using subcostal bicaval view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at 4 centimeters proximal to CAJ in superior vena cava, using apical 4-chamber view

  10. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 4: at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Immediately after the video recorded with the catheter tip at 4 centimeters proximal to the CAJ, in superior vena cava, using apical 4-chamber view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at 8 centimeters proximal to the CAJ, using subcostal 4-chamber view

  11. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 4: at 8 centimeters proximal to CAJ, using subcostal bicaval view

    Time frame: Immediately after the video recorded with the catheter tip at 8 centimeters, using subcostal 4-chamber view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at 8 centimeters proximal to the CAJ, using subcostal bicaval view

  12. Difference in "push to bubbles" time recorded with the catheter tip placed in four different positions by three different ultrasound views; measure in position 4: at 8 centimeters proximal to CAJ, using apical 4-chamber view

    Time frame: Immediately after the video recorded with the catheter tip at 8 centimeters, using subcostal bicaval view

    With the procedure described above, the "push to bubble" time will be measured with the catheter tip placed at 8 centimeters proximal to the CAJ, using apical 4-chamber view

Secondary outcomes

  1. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 1: right atrium, using subcostal 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip in right atrium, using subcostal 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip in right atrium using subcostal bicaval view

  2. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 1: right atrium, using subcostal bicaval view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed in right atrium using subcostal bicaval view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip in right atrium using subcostal bicaval view

  3. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 1: right atrium, using apical 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed in right atrium, using apical 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip in right atrium using apical 4-chamber view

  4. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 2: cavo-atrial junction (CAJ), using subcostal 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at cavo-atrial junction (CAJ), using subcostal 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at the CAJ, using subcostal 4-chamber view

  5. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 2: cavo-atrial junction (CAJ), using subcostal bicaval view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at cavo-atrial junction (CAJ), using subcostal bicaval

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at the CAJ, using subcostal bicaval view

  6. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 2: cavo-atrial junction (CAJ), using apical 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at cavo-atrial junction (CAJ), using apical 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at the CAJ, using apical 4-chamber view

  7. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 3: 4 centimeters proximal to CAJ in superior vena cava, using subcostal 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at 4 centimeters proximal to CAJ in superior vena cava, using subcostal 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at 4 centimeters proximal to CAJ in superior vena cava, using subcostal 4-chamber view

  8. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 3: 4 centimeters proximal to CAJ in superior vena cava, using subcostal bicaval view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at 4 centimeters proximal to CAJ in superior vena cava, using subcostal bicaval view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at 4 centimeters proximal to CAJ using subcostal bicaval view

  9. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 3: 4 centimeters proximal to CAJ in superior vena cava, using apical 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at 4 centimeters proximal to CAJ in superior vena cava, using apical 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at 4 centimeters proximal to CAJ in superior vena cava, using apical 4-chamber view

  10. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 4: 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at 8 centimeters proximal to the CAJ, using subcostal 4-chamber view

  11. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 4: 8 centimeters proximal to CAJ, using subcostal bicaval view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal bicaval view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at 8 centimeters proximal to the CAJ, using subcostal bicaval view

  12. Difference in time for the right atrium to be completely filled by micro bubbles; measure with the catheter tip placed in position 4: 8 centimeters proximal to CAJ, using apical 4-chamber view

    Time frame: Immediately after measuring "push to time" in the video recorded with the catheter tip placed at 8 centimeters proximal to CAJ, using apical 4-chamber view

    The time needed for the right atrium to be completely filled by micro bubbles will be measured analyzing the video recorded with the catheter tip placed at 8 centimeters proximal to the CAJ, using apical 4-chamber view

  13. Percentage in which "push to bubbles" time is evaluable using subcostal 4-chamber view

    Time frame: Immediately after every patient recruited will be evaluated with ultrasound in subcostal 4-chamber view

    To measure the percentage of the patients in which acoustic window is good enough to evaluate "push to bubbles" time using subcostal 4-chamber view.

  14. Percentage in which "push to bubbles" time is evaluable using subcostal bicaval view

    Time frame: Immediately after every patient recruited will be evaluated with ultrasound in subcostal bicaval view

    To measure the percentage of the patients in which acoustic window is good enough to evaluate "push to bubbles" time using subcostal bicaval view.

  15. Percentage in which "push to bubbles" time is evaluable using apical 4-chamber view

    Time frame: Immediately after every patient recruited will be evaluated with ultrasound in apical 4-chamber view

    To measure the percentage of the patients in which acoustic window is good enough to evaluate "push to bubbles" time using 4-chamber view.

  16. Difference between "push to bubbles" time averages measured using the three different ultrasound views with the catheter tip in right atrium

    Time frame: Immediately after "push to bubbles" time will be evaluated in every patient recruited using the three different ultrasound views with the catheter tip in right atrium

    To determine if there is a significative difference between "push to bubbles" time averages measured using the three different ultrasound views: subcostal 4-chamber view, subcostal bicaval view and apical 4-chamber view with the catheter tip in right atrium

  17. Difference between "push to bubbles" time averages measured using the three different ultrasound views with the catheter tip at the CAJ

    Time frame: Immediately after "push to bubbles" time will be evaluated in every patient recruited using the three different ultrasound views with the catheter tip at the CAJ

    To determine if there is a significative difference between "push to bubbles" time averages measured using the three different ultrasound views: subcostal 4-chamber view, subcostal bicaval view and apical 4-chamber view with the catheter tip at the CAJ

  18. Difference between "push to bubbles" time averages measured using the three different ultrasound views with the catheter tip at 4 centimeters proximal to CAJ, in superior vena cava

    Time frame: Immediately after "push to bubbles" time will be evaluated in every patient recruited using the three different ultrasound views with the catheter tip at 4 centimeters proximal to CAJ

    To determine if there is a significative difference between "push to bubbles" time averages measured using the three different ultrasound views: subcostal 4-chamber view, subcostal bicaval view and apical 4-chamber view with the catheter tip at 4 centimeters proximal to CAJ, in superior vena cava

  19. Difference between "push to bubbles" time averages measured using the three different ultrasound views with the catheter tip at 8 centimeters proximal to CAJ

    Time frame: Immediately after "push to bubbles" time will be evaluated in every patient recruited using the three different ultrasound views with the catheter tip at 8 centimeters proximal to CAJ

    To determine if there is a significative difference between "push to bubbles" time averages measured using the three different ultrasound views: subcostal 4-chamber view, subcostal bicaval view and apical 4-chamber view with the catheter tip at 8 centimeters proximal to CAJ

  20. Evaluation of the quality of bubbles flow when the catheter tip is in the right atrium, using subcostal 4-chamber view

    Time frame: Immediately after Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed in right atrium using subcostal 4-chamber view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is in the right atrium, using subcostal 4-chamber view

  21. Evaluation of the quality of bubbles flow when the catheter tip is in the right atrium, using subcostal bicaval view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed in right atrium using subcostal bicaval view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is in the right atrium, using subcostal bicaval view

  22. Evaluation of the quality of bubbles flow when the catheter tip is in the right atrium, using apical 4-chamber view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed in right atrium using apical 4-chamber view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is in the right atrium, using apical 4-chamber view

  23. Evaluation of the quality of bubbles flow when the catheter tip is at the CAJ using subcostal 4-chamber view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed in right atrium using subcostal 4-chamber view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at the CAJ, using subcostal 4-chamber view

  24. Evaluation of the quality of bubbles flow when the catheter tip is at the CAJ, using subcostal bicaval view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed at the CAJ using subcostal bicaval view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at the CAJ, using subcostal bicaval view

  25. Evaluation of the quality of bubbles flow when the catheter tip is at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

  26. Evaluation of the quality of bubbles flow when the catheter tip is at 4 centimeters proximal to CAJ, using subcostal bicaval view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal bicaval view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at 4 centimeters proximal to CAJ, using subcostal bicaval view

  27. Evaluation of the quality of bubbles flow when the catheter tip is at 4 centimeters proximal to CAJ, using subcostal apical 4-chamber view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal apical 4-chamber view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at 4 centimeters proximal to CAJ, using subcostal apical 4-chamber view

  28. Evaluation of the quality of bubbles flow when the catheter tip is at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

  29. Evaluation of the quality of bubbles flow when the catheter tip is at 8 centimeters proximal to CAJ, using subcostal bicaval view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal bicaval view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at 8 centimeters proximal to CAJ, using subcostal bicaval view

  30. Evaluation of the quality of bubbles flow when the catheter tip is at 8 centimeters proximal to CAJ, using apical 4-chamber view

    Time frame: Immediately after the evaluation of time for the right atrium to be completely filled by micro bubbles with the catheter tip placed at 8 centimeters proximal to CAJ, using apical 4-chamber view

    To evaluate the percentage in which the bubbles flow is laminar or turbulent when the catheter tip is at 8 centimeters proximal to CAJ, using apical 4-chamber view

  31. Correlation between heart rate and "push to bubbles" time measured with the catheter tip placed in right atrium using subcostal 4-chamber view

    Time frame: Heart rate will be measured immediately before the ultrasound video recording with the catheter tip placed in right atrium using subcostal 4-chamber view

    To correlate the heart rate measured immediately before the ultrasound video recording with the catheter tip placed in right atrium using subcostal 4-chamber view

  32. Correlation between heart rate and "push to bubbles" time measured with the catheter tip placed at CAJ using subcostal 4-chamber view

    Time frame: Heart rate will be measured immediately before the ultrasound video recording with the catheter tip placed at CAJ using subcostal 4-chamber view

    To correlate the heart rate measured immediately before the ultrasound video recording with the catheter tip placed at CAJ using subcostal 4-chamber view

  33. Correlation between heart rate and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, in superior vena cava, using subcostal 4-chamber view

    Time frame: Heart rate wil be measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, in superior vena cava using subcostal 4-chamber view

    To correlate the heart rate measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, in superior vena cava using subcostal 4-chamber view

  34. Correlation between heart rate and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Heart rate will be measured immediately before the ultrasound video recording with the catheter tip placed at at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the heart rate measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

  35. Correlation between systolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed in right atrium, using subcostal 4-chamber view

    Time frame: Systolic arterial blood pressure will be measured immediately before the ultrasound video recording the contrast injection with the catheter tip placed in right atrium, using subcostal 4-chamber view

    To correlate the systolic arterial blood pressure measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

  36. Correlation between systolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at CAJ, using subcostal 4-chamber view

    Time frame: Systolic arterial blood arterial pressure will be measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

    To correlate the systolic arterial blood pressure measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

  37. Correlation between systolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Systolic arterial blood pressure is measured immediately before the ultrasound video recording the contrast injection with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the systolic arterial blood pressure recorded immediately before the ultrasound video with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

  38. Correlation between systolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Systolic arterial blood pressure is measured immediately before the ultrasound video with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the systolic arterial blood pressure measured immediately before the ultrasound video with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

  39. Correlation between mean arterial blood pressure and "push to bubbles" time measured with the catheter tip placed in right atrium, using subcostal 4-chamber view

    Time frame: Mean arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip in right atrium, using subcostal 4-chamber view

    To correlate the mean arterial blood measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

  40. Correlation between mean arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at CAJ, using subcostal 4-chamber view

    Time frame: Mean arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip at CAJ, using subcostal 4-chamber view

    To correlate the mean arterial blood measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

  41. Correlation between mean arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Mean arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the mean arterial blood measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

  42. Correlation between mean arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Mean arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the mean arterial blood measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

  43. Correlation between diastolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed in right atrium, using subcostal 4-chamber view

    Time frame: Diastolic arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip in right atrium, using subcostal 4-chamber view

    To correlate the diastolic arterial blood measured immediately before the ultrasound video recording with the catheter tip placed in right atrium using subcostal 4-chamber view

  44. Correlation between diastolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at CAJ, using subcostal 4-chamber view

    Time frame: Diastolic arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip at CAJ, using subcostal 4-chamber view

    To correlate the diastolic arterial blood measured immediately before the ultrasound video recording with the catheter tip placed at CAJ using subcostal 4-chamber view

  45. Correlation between diastolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Diastolic arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the diastolic arterial blood measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ using subcostal 4-chamber view

  46. Correlation between diastolic arterial blood pressure and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Diastolic arterial blood pressure is measured immediately before the ultrasound video recording with the catheter tip at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the diastolic arterial blood measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ using subcostal 4-chamber view

  47. Correlation between systolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed in right atrium, using subcostal 4-chamber view

    Time frame: Systolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip in right atrium, using subcostal 4-chamber view

    To correlate the systolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

  48. Correlation between systolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed at CAJ, using subcostal 4-chamber view

    Time frame: Systolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip at CAJ, using subcostal 4-chamber view

    To correlate the systolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

  49. Correlation between systolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Systolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the systolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

  50. Correlation between systolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Systolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the systolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

  51. Correlation between diastolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed in right atrium, using subcostal 4-chamber view

    Time frame: Diastolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

    To correlate the diastolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

  52. Correlation between diastolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed at CAJ, using subcostal 4-chamber view

    Time frame: Diastolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

    To correlate the diastolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

  53. Correlation between diastolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Diastolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the diastolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

  54. Correlation between diastolic pulmonary artery pressure and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Diastolic pulmonary artery pressure is measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the diastolic pulmonary artery pressure measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

  55. Correlation between central venous pressure and "push to bubbles" time measured with the catheter tip placed in right atrium, using subcostal 4-chamber view

    Time frame: Central venous pressure is measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

    To correlate the central venous pressure measured immediately before the ultrasound video recording with the catheter placed in right atrium, using subcostal 4-chamber view

  56. Correlation between central venous pressure and "push to bubbles" time measured with the catheter tip placed at CAJ, using subcostal 4-chamber view

    Time frame: Central venous pressure is measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

    To correlate the central venous pressure measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

  57. Correlation between central venous pressure and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Central venous pressure is measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the central venous pressure measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

  58. Correlation between central venous pressure and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Central venous pressure is measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the central venous pressure measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

  59. Correlation between cardiac output and "push to bubbles" time measured with the catheter tip placed in right atrium, using subcostal 4-chamber view

    Time frame: Cardiac output is measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

    To correlate the cardiac output measured immediately before the ultrasound video recording with the catheter tip placed in right atrium, using subcostal 4-chamber view

  60. Correlation between cardiac output and "push to bubbles" time measured with the catheter tip placed at CAJ, using subcostal 4-chamber view

    Time frame: Cardiac output is measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

    To correlate the cardiac output measured immediately before the ultrasound video recording with the catheter tip placed at CAJ, using subcostal 4-chamber view

  61. Correlation between cardiac output and "push to bubbles" time measured with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Cardiac output is measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the cardiac output measured immediately before the ultrasound video recording with the catheter tip placed at 4 centimeters proximal to CAJ, using subcostal 4-chamber view

  62. Correlation between cardiac output and "push to bubbles" time measured with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    Time frame: Cardiac output is measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

    To correlate the cardiac output measured immediately before the ultrasound video recording with the catheter tip placed at 8 centimeters proximal to CAJ, using subcostal 4-chamber view

Sponsors and collaborators

Lead sponsor

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Other

Registry information

Official study title

Transthoracic Echocardiography With Bubble Test for Tip Location of Central Venous Catheters: a "Push to Bubble" Time Analysis

Important dates

Study start
2024
Primary completion
2024
Study completion
2025
First posted
Feb 6, 2024
Registry last updated
Dec 1, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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