Routine Post-Procedural Chest Radiographs Are Dispensable After Internal Jugular Central Venous Catheter Placement

Palaniappan, Dhamodaran; Parekh, Krishna; Seethala, Raghu R.; Deroo, Andrew; Gonzalez, C M Galindo; Panizales, Christia; Hou, Peter C.; Frendl, György

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a1625

Cited by 1 publication

(2 citation statements)

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“…[1][2][3][4][5][6] We therefore explore the evidence base surrounding POCUS confirmation after upper extremity CVC insertion [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] because it is less well known than that supporting POCUS during insertion, and because it may be time to forego the post insertion CXR. 1,2,4,[22][23][24][25][26][27][28] There has also been comparatively little discussion regarding resistance to change and therefore this is reviewed too. Overall, we explore the benefits of foregoing the routine CXR, and switching to POCUS, a technology that is (quite literally) already at hand.…”

Section: Are Routine Chest Radiographs Still Indicated After Central ...mentioning

confidence: 99%

“…Regarding detection of the CVC tip, POCUS also performs at least as well as CXR. For example, if we follow the recommendation that the tip should be between the lower third of the superior vena cava and the upper right atrium, 64,65 then CXR studies 4,24,28 identified 2% as misplaced, whereas US studies identified over 10%. 14,56 The important distinction between US and CXR however, is that US generally only permits indirect tip detection, unless that is, the wire or catheter is advanced deep into the super vena cava and/or right atrium, or is in a wayward structure.…”

Section: Confirmation Of the Cvc Tip By Pocusmentioning

confidence: 99%

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Are routine chest radiographs still indicated after central line insertion? A scoping review

Brindley,

Deschamps,

Milovanovic

et al. 2024

Journal of the Intensive Care Society

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Introduction: Central venous catheters are increasingly inserted using point-of-care ultrasound (POCUS) guidance. Following insertion, it is still common to request a confirmatory chest radiograph for subclavian and internal jugular lines, at least outside of the operating theater. This scoping review addresses: (i) the justification for routine post-insertion radiographs, (ii) whether it would better to use post-insertion POCUS instead, and (iii) the perceived barriers to change. Methods: We searched the electronic databases, Ovid MEDLINE (1946-) and Ovid EMBASE (1974-), using the MESH terms (“Echography” OR “Ultrasonography” OR “Ultrasound”) AND “Central Venous Catheter” up until February 2023. We also searched clinical practice guidelines, and targeted literature, including cited and citing articles. We included adults (⩾18 years) and English and French language publications. We included randomized control trials, prospective and retrospective cohort studies, systematic reviews, and surveys. Results: Four thousand seventy-one articles were screened, 117 full-text articles accessed, and 41 retained. Thirteen examined cardiac/vascular methods; 5 examined isolated contrast-enhanced ultrasonography; 7 examined isolated rapid atrial swirl sign; and 13 examined combined/integrated methods. In addition, three systematic reviews/meta-analyses and one survey addressed barriers to POCUS adoption. Discussion: We believe that the literature supports retiring the routine post-central line chest radiograph. This is not only because POCUS has made line insertion safer, but because POCUS performs at least as well, and is associated with less radiation, lower cost, time savings, and greater accuracy. There has been less written about perceived barriers to change, but the literature shows that these concerns- which include upfront costs, time-to-train, medicolegal concerns and habit- can be challenged and hence overcome.

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Section: Are Routine Chest Radiographs Still Indicated After Central ...mentioning

confidence: 99%

Section: Confirmation Of the Cvc Tip By Pocusmentioning

confidence: 99%

Are routine chest radiographs still indicated after central line insertion? A scoping review

Brindley,

Deschamps,

Milovanovic

et al. 2024

Journal of the Intensive Care Society

View full text Add to dashboard Cite

show abstract

Routine Post-Procedural Chest Radiographs Are Dispensable After Internal Jugular Central Venous Catheter Placement

Cited by 1 publication

References 0 publications

Are routine chest radiographs still indicated after central line insertion? A scoping review

Are routine chest radiographs still indicated after central line insertion? A scoping review

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