Chest radiograph after fluoroscopic guided line placement: No longer necessary

Infographic · Oct 2018 · 1 min read

In brief

Retrospective study of 622 fluoroscopy-guided central line placements found routine post-procedure chest radiographs unnecessary in asymptomatic patients, with zero adverse outcomes in 504 patients who did not receive imaging. Selective radiography based on symptoms achieved $142,632 in cost savings while maintaining patient safety.

Routine post-procedure chest radiographs are unnecessary after fluoroscopy-guided central line placement in asymptomatic pediatric patients.
In 504 asymptomatic patients without post-procedure imaging, zero adverse outcomes occurred over the 4.5-year study period.
Selective chest radiography (only for symptomatic patients) achieved $142,632 in cost savings without compromising patient safety.
Pneumothorax occurred in 0.6% of symptomatic patients; none required chest tube placement, suggesting low clinical significance.
Fluoroscopic guidance during placement provides adequate confirmation of catheter position, eliminating need for routine confirmatory imaging.

Written by the GCMD Library team from the infographic.

The infographic uses a teal background with three blue boxes arranged horizontally at the bottom showing outcome data. A simple line drawing of a torso with a central line is shown in the center, with an arrow pointing to a red prohibition symbol over a chest X-ray icon. The layout flows from left to right demonstrating the study's key finding that routine imaging can be safely omitted.

Purpose

Historically, a chest radiograph was obtained after central line placement in the operating room. Recent retrospective studies have questioned the need for this radiograph. The prevailing current practice at our center is to order chest radiograph only for symptomatic patients. This study examines the outcomes of selective chest radiography after fluoroscopic guided central line placement.

Methods

After obtaining institutional review board approval, a single institution retrospective chart review of patients undergoing central venous catheter placement by the pediatric surgery or interventional radiology service between January 2010 and July 2014 was performed. Outcome measures included CXR within 24 h of catheter placement, reason for chest radiograph, complication, and complication requiring intervention.

Results

In the study population 622 catheters were placed under fluoroscopy. A chest radiograph was performed in 118 (19%) patients within 24 h of the line placement with 25 (4%) of these patients being symptomatic in the recovery room. One patient required chest tube for shortness of breath and pleural effusion. Four symptomatic patients (0.6%) were found to have a pneumothorax, none of which required chest tube placement. There were no re-operations because of mal-position of the catheter. In the 504 patients with no postoperative chest x-ray, there were no adverse outcomes. At our institution the current average charge of a chest radiograph is $283, thus we produced savings of $142,632 for the study period without adverse events.

Conclusion

After placement of central venous catheter under fluoroscopic guidance, a chest radiograph is unlikely to be helpful in an asymptomatic patient.

The text in the image

Chest radiograph after fluoroscopic guided line placement: No longer necessary | Brian G.A. Dalton, Katherine W. Gonzalez, Michael C. Keirsy, Douglas C. Rivard, Shawn D. St. Peter | Journal of Pediatric Surgery, Vol. 51, Issue 9, p1490-1491 | NO NEED for Routine Chest X-ray after Central Line Placement! | (only if symptoms) | 622 catheters placed under fluoro... | 504 pts NO CXR and NO symptoms | NO Adverse Outcomes | 93 pts had CXR even with NO symptoms | NO Adverse Outcomes | 25 pts had CXR for Symptoms | 4 had PTX (2 IJ & 2 SCL) but 0 needed chest tube & | ONE had effusion and required chest tube

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