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Improving Quality of Chest Radiographs After Placement of Peripherally Inserted Central Catheters
Jill Jones1, Lucas Meek, Shaun Best
1University of Kansas Medical School (Drs Jones, Meek, Best, McCann, and Ash, and Ms Hill), and University of Wisconsin School of Medicine and Public Heath (Dr Welsh). Jill Jones, MD, is an assistant professor of radiology at the University of Kansas Medical Center (KUMC) in Kansas City, Kansas. She completed a medical doctorate, diagnostic radiology residency, and body imaging fellowship at KUMC and a visiting fellowship in body imaging at Mallinckrodt Institute of Radiology in St. Louis, Missouri. Lucas Meek, MD, is an assistant professor of radiology and section head of cardiothoracic radiology at KUMC. He completed a medical doctorate, diagnostic radiology residency, and cardiac imaging fellowship at KUMC, and a visiting fellowship in cardiothoracic imaging at Mayo Clinic in Rochester, Minnesota. Shaun Best, MD, is an assistant professor of radiology and the body imaging fellowship director at KUMC. He completed a medical doctorate and a diagnostic radiology residency at KUMC and a body imaging fellowship at the University of California, San Diego. Amy McCann, MD, completed a medical doctorate and a diagnostic radiology residency at the KUMC, where she is currently a body imaging fellow. Brandon Welsh, MD, completed a medical doctorate at Creighton University School of Medicine and a diagnostic radiology residency at KUMC. He is currently a body imaging fellow at the University of Wisconsin School of Medicine in Madison, Wisconsin. Jacqueline Hill, MPH, is the director of clinical research for the KUMC radiology department and a doctoral candidate in KUMC's health policy and management program. Ryan Ash, MD, is vice chair of radiology at KUMC. He completed a diagnostic radiology residency at KUMC and a body imaging fellowship at the University of California, San Diego. Dr Ash is currently a student in the masters of health care management program at the Harvard TH Chan School for Public Health in Boston, Massachusetts.
Abstract:
The goal of this study was to determine the best method for localizing peripherally inserted central catheters (PICCs) in postplacement portable chest radiographs. A retrospective analysis showed no significant difference in visualization of the PICC tip between different chest radiograph projections. Modifications were made to an institutional PICC protocol to obtain anteroposterior chest views with the guidewire present only. Repeat analysis demonstrated statistically significant increases in the frequency of anteroposterior radiographs performed, the number of chest radiographs with guidewire, and the localization of the catheter. By standardizing the acquisition of PICC placement chest radiographs, fewer variant projection radiographs were performed and the catheter tip was confidently localized in more examinations.
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