CAPS original papersChest radiograph after central line placement under fluoroscopy: utility or futility?
Section snippets
Methods
After institutional review board approval (05 12-153X), we conducted a retrospective review of all children who underwent central venous catheterization by the pediatric surgery service at Children's Mercy Hospital from January 2004 to December 2005. Central venous catheters placed by interventional radiology and peripherally inserted central catheters lines were excluded from our study. Demographic data included age and sex. Data collected included use of fluoroscopy, postoperative chest x-ray
Results
A total of 237 central lines were placed by the surgery service during the examined time period. Mean patient age was 4.9 ± 5.5 years (range, 0-18 years). The group was composed of 124 males and 113 females. There were 2 complications; both pneumothoraces (0.085%). One patient became symptomatic with shortness of breath and required tube thoracostomy, whereas the other was asymptomatic and the pneumothorax resolved spontaneously. Fourteen patients had no postoperative chest film and there were
Discussion
Data currently accumulating in the adult literature have suggested a postoperative chest film may not be necessary if a central line is placed under fluoroscopic guidance [1], [3], [4], [5], [6], [7], [8]. A single retrospective review of a pediatric population has been published that, similar to our experience, documented a total complication rate of 1.6%, with a complication rate of 0.6% in the subgroup where fluoroscopy was used for placement of the catheters [2]. The authors concluded that
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Cited by (20)
Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value
2020, Journal of Surgical ResearchCitation Excerpt :The introduction of intraoperative ultrasonography and fluoroscopy is likely the principal reason for this improvement, increasing the accuracy of anatomic and catheter-position verification.6 In this context, our finding of 1% pneumothorax rate is comparable to the 0.6%-0.8% rate reported in most pediatric studies where routine postoperative CXRs were obtained.9,10 However, the incidence of additional technical complications after CVL placement in the pediatric literature is generally under-reported, as most retrospective studies report only complications that become symptomatic.15
Simple preoperative radiation safety interventions significantly lower radiation doses during central venous line placement in children
2019, Journal of Pediatric SurgeryCitation Excerpt :The radiation time-out draws upon the principles of structured surgical checklists, which have been shown to be low-cost, highly effective tools for improving patient outcomes and reducing complications [34–36]. The consistent use of the last-image-hold allowed for the elimination of routine postoperative chest radiographs in asymptomatic patients without increased postoperative complications, confirming the findings of prior studies [4,37–40]. Avoiding this unnecessary test produced an additional modest reduction in patient dose; while we did not measure this exact dose reduction, prior studies estimate that DAP from a single postoperative chest radiograph ranges from 9.4 to 17 rad·cm2 [41–43].
Routine chest X-ray is unnecessary after ultrasound-guided central venous line placement in the operating room
2018, Journal of Critical CareCitation Excerpt :Due to advancement of devices and insertion techniques, complication rates have steadily declined. It is now recommended that CVCs be placed using ultrasound guidance, reducing the risk of early complications to below 5% in some series [12-19]. In a study by O. Molgaard and colleagues, none of 42 patients who received a CVC without a follow-up CXR was found to have related complications during their hospitalization.
Chest radiograph after fluoroscopic guided line placement: No longer necessary
2016, Journal of Pediatric SurgeryCitation Excerpt :The pneumothorax rate was not significantly different for the 2 services, occurring in 2 of 205 (1%) patients on the surgery service and 2 of 417 (0.5%) patients of lines placed by interventional radiology, p = 0.6. Previous studies have questioned the necessity of chest radiograph in both children and adults [1–4]. A previous study from our center showed a very low complication rate (0.8%) and need for one chest tube out of 237 patients.
Presented at the 39th Annual Meeting of the Canadian Association of Pediatric Surgeons, August 23-26, 2007, St John's Newfoundland, Canada.