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The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
Published on: December 23, 2014
Routine chest X-ray following ultrasound-guided internal jugular vein catheterization in critically ill children: A
Avichai Weissbach1,2, Yulia Gendler3,4, Yaniv Lakovsky2,5
1Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Insights
Routine chest X-rays after ultrasound-guided central venous catheter insertion in critically ill children are unnecessary. Immediate use of central venous catheters is safe, as chest X-rays rarely alter management.
Area of Science:
- Pediatric Intensive Care
- Medical Imaging
- Vascular Access
Background:
- Studies in adults suggest routine chest X-rays post-central venous catheter (CVC) insertion are unnecessary.
- Ultrasound guidance for CVC insertion is increasingly common.
- Complication rates for CVC insertion are generally low.
Purpose of the Study:
- To evaluate the utility of routine chest X-rays following ultrasound-guided CVC insertion in critically ill children.
- To determine if chest X-rays impact clinical management in this pediatric population.
Main Methods:
- Prospective observational study in a pediatric intensive care unit.
- Included children under 18 undergoing ultrasound-guided internal jugular vein CVC insertion.
- Chest X-rays were analyzed for pneumothorax, hemothorax, and CVC tip position.
Main Results:
- 99 CVCs were inserted out of 105 attempts; all were within the venous system.
- No pneumothorax or hemothorax was detected on chest X-ray.
- 20.2% of CVCs were malpositioned by strict criteria, but only 1% required repositioning.
Conclusions:
- Routine chest X-rays are not essential for critically ill children receiving ultrasound-guided CVCs.
- Immediate use of CVCs is safe, as chest X-rays rarely change patient management.
- Delaying CVC use for chest X-ray is not supported by these findings.
Background:
Recent studies in adults have shown that routine chest X-ray following ultrasound-guided central venous catheter insertion through the internal jugular vein is unnecessary due to a low rate of complications.
Aims:
To assess the usefulness of routine chest X-ray following ultrasound-guided central venous catheter insertion through the internal jugular veins in critically ill children.
Methods:
A prospective observational study was conducted at a pediatric intensive care unit of a tertiary, university-affiliated pediatric medical center. All children under the age of 18 who underwent ultrasound-guided central venous catheter insertion through the right or left internal jugular vein between May 2018 and November 2019 were evaluated for eligibility. Procedures were prospectively documented, and chest X-ray was screened for pneumothorax, hemothorax, central venous catheter tip position, and resultant corrective interventions.
Results:
Of 105 central venous catheter insertion attempts, 99 central venous catheters (94.3%) were inserted. All were located within the venous system. None were diagnosed with pneumo/hemothorax on chest X-ray. Twenty (20.2%; 95% CI 12.8%-29.5%) were defined as malpositioned by strict criteria; however, only one (1%) was judged significantly misplaced by the clinical team leading to its repositioning.
Conclusions:
In this critically ill pediatric cohort, all central venous catheters inserted under ultrasound guidance could have been used with safety prior to acquiring chest X-ray. Overall chest X-ray impacted patient management in only 1% of cases. Our results do not support delaying urgent central venous catheter use pending chest X-ray completion in critically ill children.
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