중심정맥도관의 우심방 내 위치 분류 및 예측
Classification and Prediction of Right Atrium Positioning of a Central Venous Catheter
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Objectives: Central venous catheter (CVC) insertion is one of the most frequently performed procedures during critical care. Confirming proper placement of catheter tip is very important during the procedure because right atrial placement of CVC may increase the risk of fatal complications as perforation and cardiac tamponade. This study was performed to check the usefulness of tip-to-carina (TC) distance and to compare the accuracy among various classification models for predicting RA positioning of a CVC. Methods: This study reviewed retrospectively medical records and picture archiving communication system of patients who were given chest computed tomography within 12 hours after CVC insertion between May 2002 and April 2012. Bivariate analyses were conducted relating physical and radiologic methods to predict RA placement of a CVC tip. A multiple logistic regression model was then derived, with all variables in the final model significant at p<0.05. Full and TC distance based models including linear discriminant analysis, classification and regression tree, bagging, random forest and support vector machine were developed and compared the area under ROC curve (AUROC), sensitivity and specificity using training and test data. Each modeling was conducted ten times. Results: Among 120 cases, 24 tips were placed in RA. Significant predictable factors were rib level, age and TC distance (all p-value <0.001). TC distance ( p=0.001) was independently valid in multiple logistic regression. Both full and reducted models using TC distance in five classification methods showed high values of accuracy (above 88%) and AUROC (above 0.89). There were no statistically significant difference between full and reducted model in AUROC. The cut-off value for TC distance for detecting RA positioning of a CVC was 43.65 mm (sensitivity=83.3%, specificity=95.8%). Conclusions: TC distance is a useful marker for detecting RA positioning of a CVC.
Abstract
Objectives: Central venous catheter (CVC) insertion is one of the most frequently performed procedures during critical care. Confirming proper placement of catheter tip is very important during the procedure because right atrial placement of CVC may increase the risk of fatal complications as perforation and cardiac tamponade. This study was performed to check the usefulness of tip-to-carina (TC) distance and to compare the accuracy among various classification models for predicting RA positioning of a CVC. Methods: This study reviewed retrospectively medical records and picture archiving communication system of patients who were given chest computed tomography within 12 hours after CVC insertion between May 2002 and April 2012. Bivariate analyses were conducted relating physical and radiologic methods to predict RA placement of a CVC tip. A multiple logistic regression model was then derived, with all variables in the final model significant at p<0.05. Full and TC distance based models including linear discriminant analysis, classification and regression tree, bagging, random forest and support vector machine were developed and compared the area under ROC curve (AUROC), sensitivity and specificity using training and test data. Each modeling was conducted ten times. Results: Among 120 cases, 24 tips were placed in RA. Significant predictable factors were rib level, age and TC distance (all p-value <0.001). TC distance ( p=0.001) was independently valid in multiple logistic regression. Both full and reducted models using TC distance in five classification methods showed high values of accuracy (above 88%) and AUROC (above 0.89). There were no statistically significant difference between full and reducted model in AUROC. The cut-off value for TC distance for detecting RA positioning of a CVC was 43.65 mm (sensitivity=83.3%, specificity=95.8%). Conclusions: TC distance is a useful marker for detecting RA positioning of a CVC.
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