Bedside Ultrasound Confirms Central Line Tip Position Faster Than Chest X-Ray

Point of care ultrasound, using a sign known as the Rapid Atrial Swirl Sign (RASS), confirmed the position of central venous catheter tips with high accuracy and notably faster than chest X-ray in a prospective diagnostic accuracy study published in BMC Emergency Medicine. The study, led by Muhammed Mustafa Demir and colleagues, evaluated 82 patients who had catheters placed via the internal jugular or subclavian vein in emergency and critical care settings.

For confirming catheter tip proximity to the right atrium, the ultrasound approach showed 100% sensitivity, though with a very wide 95% confidence interval of 2.5% to 100%, and 98.77% specificity (95% CI 93.31% to 99.97%). The authors report a high rate of correct placement among RASS-positive cases. However, the sensitivity estimate rests on a single confirmed malposition event in the cohort, which the researchers themselves flag as a key limitation.

Neither method detected any pneumothorax or hemothorax, yielding 100% raw agreement between the two techniques. Because no reference-standard-positive complication case occurred, sensitivity and positive predictive value for thoracic complication detection could not be estimated. The apparent 100% specificity and negative predictive value therefore reflect this zero-prevalence sample rather than demonstrated discriminative accuracy for detecting complications.

Speed was the clearest advantage. Ultrasound assessments were completed a median of 21.0 minutes faster than chest X-ray, with a paired-difference interquartile range of 11 to 37 minutes; the difference was statistically significant on a Wilcoxon signed-rank test (p < 0.001). In busy emergency departments, where central venous catheter placement is a commonly performed invasive procedure carrying the risk of various complications, that time saving could matter for early confirmation of line safety.

The authors conclude that POCUS with RASS rapidly and consistently confirmed catheter tip position in this cohort, with a clear time advantage over chest radiography. They caution, however, that given the single confirmed malposition event and the complete absence of thoracic complications, the findings should be regarded as preliminary feasibility and concordance data. Larger, adequately powered studies are needed before this ultrasound approach can be recommended to replace or reduce routine chest X-ray use after central venous catheter insertion.

Subject of Research: Diagnostic accuracy of point of care ultrasound for central venous catheter tip confirmation and mechanical complication detection

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

Article References: Demir, M. M., Yıldırım, C., Sabak, M., Yıldız, A. F., Demir, Ö., & Karaduman, M. E. (2026). Point of care ultrasound for confirmation of central venous catheter tip position and detection of early mechanical complications: a prospective diagnostic accuracy study. BMC Emergency Medicine. https://doi.org/10.1186/s12873-026-01812-4

Image Credits: AI Generated

DOI: 10.1186/s12873-026-01812-4

Keywords: point of care ultrasound, central venous catheter, Rapid Atrial Swirl Sign, diagnostic accuracy, pneumothorax, hemothorax, chest X-ray, emergency medicine, catheter tip position, prospective study, Point, care