IMPORTANCE OF DOPPLER ANALYSIS OF TRANSMITTED ATRIAL WAVE-FORMS PRIORTO PLACEMENT OF CENTRAL VENOUS ACCESS CATHETERS

PURPOSE: To assess the sensitivity of Doppler flow analysis of the axi llary and internal jugular veins to screen for clinically occult thora cic central veno-occlusive disease and predict successful placement of central access catheters, MATERIALS AND METHODS: Sixty-seven patients underwent both duplex sonographic evaluation of the axillary and inte rnal jugular veins and contrast venography prior to placement of a cen tral venous catheter, Duplex evaluation included visual evidence of ve noocclusive disease as well as the presence or absence of normal trans mitted polyphasic atrial waves and respiratory variation of flow, Diag nostically adequate venograms were available for comparision with the duplex sonograms in 168 access routes (access site plus downstream con duit veins), The contrast venograms and sonograms were compared by usi ng retrospective blinded interpretation, Outcome of attempted catheter placement was tabulated, RESULTS: Directed sonographic imaging of the axillary and internal jugular vein allowed detection of access route veno-occlusive disease with a sensitivity of only 33.3%, Alternatively , when Doppler flow analysis found atrial waveforms that were not poly phasic, central conduit occlusive disease was detected with a sensitiv ity of 79.6%, Monophasic atrial waveforms were associated with a 25% f ailure rate of catheterization due to central vein occlusive disease, whereas polyphasic atrial waveforms were correlated with a 100% succes s rate for catheter placement, CONCLUSION: In asymptomatic patients, s onographic imaging alone misses most instances of central veno-occlusi ve disease, However, Doppler flow analysis of transmitted atrial wavef orms substantially improved the sensitivity, A normal polyphasic atria l waveform virtually excludes the possibility of a more central venous occlusion or stenosis greater than 80% and ensures an adequate route for central venous catheterization.