Is Routine Chest X-Ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely?

Chui, Jason; Saeed, Rasha; Jakobowski, Luke; Wang, Wanyu; Eldeyasty, Basem; Zhu, Fang; Fochesato, Lee-Anne; Lavi, Ron; Bainbridge, Daniel

doi:10.1016/j.chest.2018.02.017

Cited by 44 publications

(54 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Based on a previous retrospective report in critically ill children 15 and our experience, we made a conservative estimate of an 8% complication rate in children versus 2.3% in adults. 8 In order to allow detection of this difference in complication rate with 80% power and a two-…”

Section: Discussionmentioning

confidence: 99%

“…However, the justification for this practice was recently questioned in two large retrospective studies in adults which showed that CVC inserted under US guidance is associated with a very low rate of complications. 8,9 In children, three studies have shown that using either fluoroscopy or point-of-care echocardiography can obviate the need for CXR, [10][11][12] but neither of these procedures is routinely performed during CVC insertion in the pediatric intensive care unit (PICU). While US guidance has radically improved the safe insertion of CVCs in children, postprocedure CXR continues to be performed.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…This value is significantly higher (P < .001) than the 1.91% rate (131/6875) reported in the adult population, using the same definition of misplacement. 8 Table 2 summarizes the complication rates. The results of the binary logistic regression analysis for CVC misplacement are presented in Table 3.…”

Section: Re Sultsmentioning

confidence: 99%

See 2 more Smart Citations

Routine chest X‐ray following ultrasound‐guided internal jugular vein catheterization in critically ill children: A prospective observational Study

Weissbach

Gendler

Lakovsky

et al. 2020

Pediatric Anesthesia

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%

See 1 more Smart Citation

Routine chest X‐ray following ultrasound‐guided internal jugular vein catheterization in critically ill children: A prospective observational Study

Weissbach

Gendler

Lakovsky

et al. 2020

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…Im Zentrum #1 war die Gruppe der unerfahrenen Ärzte/Ärztinnen im Vergleich zum Zentrum #2 deutlich größer (33,2 % vs. 46,9 %); dies zeigte sich in den vorab publizierten Ergebnissen entsprechend in den Komplikationsraten der Studienzentren [25]. Die Gesamtrate an Pneumothoraces in den 3 Kategorien (0-20: 1,3 %, 21-50: 2,5 %, >50: 0,3 %; gesamte Population 2,2 %) liegt im üblichen Bereich, der auch von anderen Autoren berichtet wurde [6,19].…”

Section: Diskussionunclassified

Komplikationen und Erfolgsraten des Vena-subclavia-Katheters in Abhängigkeit der Erfahrung

et al. 2020

View full text Add to dashboard Cite

Zusammenfassung Hintergrund Die Punktion der V. subclavia gehört zu den Standardprozeduren eines/einer Anästhesisten/Anästhesistin. Gefürchtete Komplikationen dieser Prozedur sind der Pneumothorax und die arterielle Fehlpunktion. Zum Erlernen dieser Prozedur ist von einer gewissen Lernkurve auszugehen. Ziel der Arbeit In dieser Studie soll der Einfluss der Punktionserfahrung auf die Erfolgsquote und mechanische Komplikationen wie Pneumothorax und arterielle Punktion untersucht werden. Dazu sollen 3 Erfahrungsstufen miteinander verglichen werden: unerfahren: 0 bis 20 Punktionen, mäßig erfahren: 21 bis 50 und erfahren: über 50 Punktionen. Material und Methoden Post-hoc-Analyse einer vorab publizierten Nichtunterlegenheitsstudie zur Untersuchung des Einflusses der Beatmung auf die Pneumothoraxrate bei der V.-subclavia-Punktion in Landmarkentechnik. Es wurden 1021 Patienten ausgewertet, die in die vorab publizierte Studie zwischen August 2014 und Oktober 2017 eingeschlossen wurden. Ergebnisse Die Gesamtrate an mechanischen Komplikationen ist in der Gruppe der Unerfahrenen im Vergleich zur Gruppe der Erfahrenen signifikant höher (15 % vs. 8,5 %, p = 0,023). Ebenso ist die Rate an Punktionsversuchen in der Gruppe der Unerfahrenen (0–20) mit 1,85 ± 1,12 signifikant höher als in der Gruppe der Erfahrenen (1,58 ± 0,99, p = 0,004). Im Gegenzug war die Rate einer erfolgreichen Punktion mit 95,1 % in der Gruppe der Erfahrenen signifikant höher als in der Gruppe der Unerfahrenen (89,3 %, p = 0,001). Schlussfolgerung Für eine erfolgreiche Punktion der V. subclavia in Landmarkentechnik ist eine Lernkurve von mindestens 50 Punktionen nötig, um die Komplikationsrate zu senken und die Erfolgsrate zu steigern.

show abstract

“…Outros métodos que podem ser utilizados para a avaliação da função pulmonar merecem menção. A radiografia convencional de tórax é um método rápido e à beira-leito comumente utilizada para avaliação da função pulmonar em pacientes internados na UTI em situações que não restritas aos pacientes com SDRA, como na detecção de pneumotórax ou na verificação da posição do tubo orotraqueal ou de cateter venoso central [97,98]. Ainda que seja necessária para o diagnóstico de ARDS [99] é considerada um método questionável para a detecção de atelectasias em pacientes em supino [100].…”

Section: Métodos De Imagem Para Avaliação Da Função Pulmonarunclassified

Determinação da PEEP ideal e evolução da função pulmonar por tomografia de impedância elétrica durante o intraoperatório de cirurgia eletiva

Pereira¹

View full text Add to dashboard Cite

Vinte pacientes submetidos à cirurgia laparoscópica e vinte pacientes submetidos à cirurgia aberta foram incluídos. A mediana de PEEP titulada foi 12 cmH2O (10-14), com uma ampla variação de 6-16 (IC 95% 10-14). O uso da PEEP titulada determinou uma redução da pressão de distensão (p<0,001), melhora da complacência (p<0,001), melhora a oxigenação (p<0,001) apenas dos pacientes de cirurgia laparoscópica e redução da massa de tecido pulmonar não-aerada após a extubação (P<0,05). Conclusão: A PEEP individualizada apresentou ampla distribuição. A individualização da PEEP reduziu a quantidade de atelectasia após a extubação e, também, melhorou a mecânica respiratória e a oxigenação. Clinical Trials: NCT02314845 Descritores: respiração artificial; titulação da PEEP; período intraoperatório; mecânica respiratória; atelectasia pulmonar; tomografia por impedância elétrica.

show abstract

Is Routine Chest X-Ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely?

Cited by 44 publications

References 44 publications

Routine chest X‐ray following ultrasound‐guided internal jugular vein catheterization in critically ill children: A prospective observational Study

Routine chest X‐ray following ultrasound‐guided internal jugular vein catheterization in critically ill children: A prospective observational Study

Komplikationen und Erfolgsraten des Vena-subclavia-Katheters in Abhängigkeit der Erfahrung

Determinação da PEEP ideal e evolução da função pulmonar por tomografia de impedância elétrica durante o intraoperatório de cirurgia eletiva

Contact Info

Product

Resources

About