Routine chest X-rays after insertion of implantable long-term venous catheters: necessary or not?

Area of Science:

• Medical Devices
• Interventional Radiology
• Surgical Procedures

Background:

• Long-term venous access is crucial for patient care.
• Routine post-insertion chest X-rays (CXRs) for Mediport catheters are standard but resource-intensive.
• Evaluating alternative protocols for Mediport placement is necessary.

Purpose of the Study:

• To assess the safety and efficacy of Mediport catheter insertion without routine post-procedure chest X-ray (CXR) verification.
• To determine complication rates associated with a selective CXR protocol.

Main Methods:

• A single surgeon performed 513 consecutive Mediport catheter insertions over 5 years.
• A standardized protocol was used with selective indications for follow-up CXR.
• Indications for CXR included chest pain, air aspiration, decreased breath sounds, and difficult insertion.

Main Results:

• Six pneumothoraces (1.2% incidence) occurred, all in patients meeting criteria for immediate CXR.
• Overall complication rate was 3.1%, including catheter malposition and hematomas.
• 90% of catheters were placed percutaneously via the subclavian vein.

Conclusions:

• Mediport catheter insertion can be safely performed with minimal complications using a standardized protocol.
• Selective radiologic evaluation, rather than routine CXR, is a viable approach.
• This strategy can lead to substantial healthcare resource savings.