Is Routine Chest X-ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely? A population-based retrospective study of 6875 patients.

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Is Routine Chest X-ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely? A population-based retrospective study of 6875 patients.

Chest. 2018 Feb 28;:

Authors: Chui J, Saeed R, Jakobowski L, Wang W, Eldeyasty B, Zhu A, Fochesato L, Lavi R, Bainbridge D

Abstract
BACKGROUND: A routine chest X-ray (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. We sought to assess the value of a routine post-procedural CXR in the era of ultrasound-guided CVC insertion.
METHODS: We performed a population-based retrospective cohort study to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008 and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. We performed a logistic regression analysis to examine the potential risk factors associated with these complications, and a cost analysis to evaluate the economic impact.
RESULTS: Of 18274 patients who had a CVC inserted, 6875 patients were included. The overall incidence of pneumothorax and catheter misplacement was 0.33% [95%CI: 0.22- 0.5%] (23 patients) and 1.91% [95% CI: 1.61- 2.26] (131 patients), 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 [OR: 6.69 (2.45 - 18.28); p<0.001], and catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Expenditures on routine post-procedural CXR were $105,000-$183,000 per year at our institution.
CONCLUSIONS: This study shows that pneumothorax and catheter misplacement after ultrasound-guided CVC insertion were rare and the costs of a post-procedural CXR was exceedingly high. We concluded that a routine post-procedural CXR is unnecessary and not choosing-wisely in our setting.

PMID: 29501497 [PubMed - as supplied by publisher]

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