Original Article

Confirmatory Chest Radiographs after Central Line Placement: Are They Warranted?

Authors: Larry E. Puls, MD, Carrie Ann Twedt, MD, James E. Hunter, MD, Eugene M. Langan, MD, Martin Crane, PhD

Abstract

Objectives This study was designed to determine the ability of physicians to predict complications associated with the placement of central venous access devices and to decide whether a confirmatory chest radiograph is warranted after placement. Methods Patients receiving central venous access on an inpatient and outpatient gynecologic oncology service were studied. Data were collected regarding patient demographics, patient history, procedural details of the placement, and the type of catheter used. The physician then predicted which patients had a reasonable potential for placement complications. All of the patients then underwent radiography, which was then compared with the original prediction. Results Ninety-eight patients who had central venous access devices placed were included in the study. Eighty of the 81 central lines thought by the practitioner to have been placed without incident caused no significant complications; one individual in this group had a minor pneumothorax. Two of 17 patients predicted to have complications were noted to have a pneumothorax that required hospitalization. No patients in the low-risk group were hospitalized for a placement complication, whereas two hospitalizations occurred in the high-risk group. Conclusion Confirmatory chest radiographs may potentially be omitted in certain cases after line placement when experienced clinicians use good technique, good clinical judgment, and discrimination.

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References

1. Aubaniac RL. Intravenous subclavicular injection [in French]. Presse Med 1952; 60: 1456–1458.
 
2. Wilson IN, Grow JB, Demong CV, et al. Central venous pressure in optimal blood volume maintenance. Arch Surg 1962; 85: 563–578.
 
3. Dudrick SJ, Wilmore DW, Vars HM, et al. Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery 1968; 64: 134–142.
 
4. Collier PE, Blocker SH, Graff DM, et al. Cardiac tamponade from central venous catheters. Am J Surg 1998; 176: 212–214.
 
5. Moskal TL, Ray CE Jr. Left mediastinal central line malposition: A case report. Angiology 1999; 50: 349–353.
 
6. Murray BH, Cohle SD, Davison P. Pericardial tamponade and death from Hickman catheter perforation. Am Surg 1996; 62: 994–997.
 
7. Lo WK, Chong JL. Neck haematoma and airway obstruction in a pre-eclamptic patient: A complication of internal jugular vein cannulation. Anaesth Intensive Care 1997; 25: 423–425.
 
8. Lowell JA, Bothe A Jr. Venous access: Preoperative, operative, and postoperative dilemmas. Surg Clin North Am 1991; 71: 1231–1246.
 
9. Ryan JA Jr, Abel RM, Abbott WM, et al. Catheter complications in total parenteral nutrition: A prospective study of 200 consecutive patients. N Engl J Med 1974; 290: 757–761.
 
10. Amshel CE, Palesty JA, Dudrick SJ. Are chest X-rays mandatory following central venous recatheterization over a wire? Am Surg 1998; 64: 499–502.
 
11. Scott WL. Central venous catheters: An overview of Food and Drug Administration activities. Surg Oncol Clin N Am 1995; 4: 377–393.
 
12. Lefrant JY, Cuvillon P, Benezet JF, et al. Pulsed Doppler ultrasonography guidance for catheterization of the subclavian vein: A randomized study. Anesthesiology 1998; 88: 1195–1201.
 
13. Kaufman JL, Rodriguez JL, McFadden JA, et al. Clinical experience with the multiple lumen central venous catheter. JPEN J Parenter Enteral Nutr 1986; 10: 487–489.
 
14. Palesty JA, Amshel CE, Dudrick SJ. Routine chest radiographs following central venous recatheterization over a wire are not justified. Am J Surg 1998; 176: 618–621.
 
15. Herbst CA Jr. Indications, management, and complications of percutaneous subclavian catheters: An audit. Arch Surg 1978; 113: 1421–1425.
 
16. Bernard RW, Stahl WM. Subclavian vein catheterizations: A prospective study— Part I: Non-infectious complications. Ann Surg 1971; 173: 184–190.
 
17. Riblet JL, Shillinglaw W, Goldberg AJ, et al. Utility of the routine chest X-ray after “over-wire” venous catheter changes. Am Surg 1996; 62: 1064–1065.
 
18. Cullinane DC, Parkus DE, Reddy VS, et al. The futility of chest roentgenograms following routine central venous line changes. Am J Surg 1998; 176: 283–285.
 
19. Farrell J, Walshe J, Gellens M, et al. Complications associated with insertion of jugular venous catheters for hemodialysis: The value of postprocedural radiograph. Am J Kidney Dis 1997; 30: 690–692.
 
20. Gray P, Sullivan G, Ostryzniuk P, et al. Value of postprocedural chest radiographs in the adult intensive care unit. Crit Care Med 1992; 20: 1513–1518.
 
21. Slama M, Novara A, Safavian A, et al. Improvement of internal jugular vein cannulation using an ultrasound-guided technique. Intensive Care Med 1997; 23: 916–919.
 
22. Fry WR, Clagett GC, O'Rourke PT. Ultrasound-guided central venous access. Arch Surg 1999; 134: 738–741.