Point of care ultrasound for confirmation of central venous catheter tip position and detection of early mechanical complications: a prospective diagnostic accuracy study

Central venous catheter (CVC) placement is a commonly performed invasive procedure in emergency and critical care settings, carrying the risk of various complications. This study investigated the effectiveness of point of care ultrasound (POCUS), using the Rapid Atrial Swirl Sign (RASS), for confirming catheter tip proximity to the right atrium, and separately assessed complications following CVC insertion. In patients who underwent CVC placement via the internal jugular vein or subclavian vein, this study investigated the effectiveness of point of care ultrasound (POCUS), using the Rapid Atrial Swirl Sign (RASS), for confirming catheter tip proximity to the right atrium, and separately assessed pneumothorax and hemothorax, using both POCUS and chest X-ray (CXR). The diagnostic performance of POCUS was evaluated in 82 patients who met the inclusion criteria. In this prospective diagnostic accuracy study, POCUS demonstrated 100% sensitivity (95% CI 2.5–100%) and 98.77% specificity (95% CI 93.31–99.97%) for catheter tip placement, with a high rate of correct placement among RASS-positive cases. No pneumothorax or hemothorax was detected by either method (100% raw agreement); sensitivity and PPV for thoracic-complication detection could not be estimated because no reference-standard-positive case occurred, and the resulting specificity/NPV of 100% reflect this zero-prevalence sample rather than demonstrated discriminative accuracy. POCUS was completed a median of 21.0 min faster than CXR (paired-difference IQR 11–37 min; Wilcoxon signed-rank test, p < 0.001). POCUS/RASS rapidly and consistently confirmed catheter tip position in this cohort, with a clear time advantage over CXR; given the single confirmed malposition event and the absence of thoracic complications, these findings should be regarded as preliminary feasibility and concordance data warranting confirmation in larger, adequately powered studies before POCUS/RASS can be recommended to replace or reduce routine CXR use.