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Published on: December 23, 2014
Are routine chest radiographs needed after fluoroscopically guided percutaneous insertion of central venous catheters
Hussamuddin Adwan1, Hannah Gordon, Eric Nicholls
1Department of Paediatric Surgery, St George's Hospital, SW17 0QT London, UK.
Insights
Routine postprocedural chest x-rays after central venous catheter (CVC) insertion in children are not cost-effective. This practice exposes children to unnecessary radiation without significant clinical benefit.
Area of Science:
- Pediatric Interventional Radiology
- Medical Imaging
- Healthcare Management
Background:
- Current guidelines recommend routine postprocedural chest x-rays for central venous catheter (CVC) placement in children.
- This practice carries risks of radiation exposure, increased patient stress, and additional costs.
Purpose of the Study:
- To evaluate the impact and cost-effectiveness of routine postprocedural radiographs following fluoroscopically guided CVC insertions in pediatric patients.
Main Methods:
- Retrospective review of 280 pediatric patients (ages 4-16) who underwent fluoroscopically guided CVC insertion between 2000-2005.
- Inclusion criteria: reported postprocedural radiographs; medical notes reviewed for complications.
Main Results:
- Only 0.7% of patients (2 out of 280) had reported complications.
- Complications included asymptomatic pneumothorax and a slight line kink; both lines remained functional without requiring intervention.
Conclusions:
- Routine postprocedural radiographs after fluoroscopically guided CVC insertion in children lack justification when no clinical indications are present.
- The practice is not cost-effective and exposes children to unnecessary radiation.
Unlabelled:
Current guidelines for children still mandate routine postprocedural chest x-ray to confirm placement and detect complications. This is in spite of the risk of unnecessary exposure to radiation, the additional stress to children and their parents, and the cost of this practice. We studied the impact and cost-effectiveness of this practice on the management of children after percutaneous fluoroscopically guided central venous catheter (CVC) insertions.
Methods:
A retrospective review of children who underwent percutaneous fluoroscopically guided CVC insertions between January 2000 and December 2005. Only patients with reported postprocedural radiographs in the electronic database were included, and we referred to the medical notes when the report indicated a complication.
Results:
Two hundred eighty consecutive patients aged between 4 and 16 years were identified. Two hundred seventy-eight (99.3%) of the reports indicated absence of complications, whereas only 2 reports (0.7%) indicated any form of complications. Of the 2 complications detected, 1 was an asymptomatic pneumothorax, and the other was a slight kink in the line; on review of the medical notes, both lines were fully functional and neither required treatment.
Conclusion:
After percutaneous fluoroscopically guided CVC insertions and in the absence of clinical indications, the use of routine postprocedural radiographs in children cannot be justified and is not cost-effective.
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