Routine X-Ray Not Needed After US-Guided Central Line Insertion

Pneumothorax and catheter misplacement after ultrasound-guided central venous catheter (CVC) insertion were rare, and the costs of a postprocedural chest X-ray (CXR) were exceedingly high, according to a study published in the CHEST journal. The study suggested that a routine postprocedural CXR is unnecessary and not a wise choice.

A routine chest radiograph (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. Jason Chui and his associates conducted a study to assess the value of a routine postprocedural CXR in the era of ultrasound-guided CVC insertion.

The investigators performed a population-based retrospective cohort study to review the records of all adult patients who had a CVC inserted in the operating room and determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. The researchers then examined the potential risk factors associated with these complications and analyzed the cost to evaluate the economic impact. A total of 6,875 patients were included in the study.

Key study findings:

• The overall incidence of pneumothorax and catheter misplacement was 0.33% and 1.91% respectively.


• The site of catheterization was the major determinant of pneumothorax and catheter misplacement; left subclavian vein catheterization was the site at a higher risk for pneumothorax.


• Catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Expenditures on routine postprocedural CXR were the US $105,000 to $183,000 per year.

According to the authors, a routine post-procedural CXR is unnecessary and not a wise choice.

For reference log on to https://doi.org/10.1016/j.chest.2018.02.017