Malposition in central venous catheterization and the use of ultrasonography: Is the presence of turbulent flow an alternative to chest radiography

Aim: To evaluate the rate of malposition in central venous catheterization (CVC) procedures performed by expert physicians in our intensive care units using ultrasound (US). Additionally, we investigated whether the assessment of turbulent flow via USG could eliminate the need for chest radiography and whether USG could serve as a viable alternative to radiographic confirmation. Methods: This prospective observational study was conducted between June 2024 and January 2025 in the intensive care units of Mardin Training and Research Hospital. A total of 162 adult patients who underwent CVC placement were included. Patients were divided into three groups: (1) Conventional CVC placement (n = 53), (2) US-guided CVC placement (n = 51), and (3) US-guided CVC placement with turbulent flow assessment (n = 58). The presence of turbulent flow in the right atrium was evaluated using a rapid injection of saline. The malposition rate and complications were compared among groups. Results: The malposition rate was significantly lower in the US + Turbulent Flow Group (1.5%, n = 1/58) compared to the Conventional CVC Group (7.5%, n = 4/53) and the USG-Guided Group (4.3%, n = 2/51) (p = 0.022). Additionally, no complications were observed in the US-Guided and US + Turbulent Flow Groups, whereas the complication rate in the Conventional CVC Group was 6.67% (n = 4/53) (p = 0.010). Regression analysis showed that turbulent flow detection was significantly associated with correct catheter positioning (p = 0.018, Beta = 2.361). Conclusion: Our findings suggest that US, particularly with turbulent flow assessment, is a highly effective method for confirming CVC placement and may reduce the need for routine chest radiography. The use of US-guided techniques significantly lowers the malposition rate and enhances patient safety. Incorporating turbulent flow assessment into clinical protocols may improve the accuracy of catheter placement and minimize complications.