No CXR After Central Line Placement
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Key Takeaways
- Routine chest X-rays after fluoroscopy-guided central line placement are unnecessary in asymptomatic patients (504/504 had no adverse outcomes).
- Only symptomatic patients require post-procedure imaging: 4/25 symptomatic patients had pneumothorax, managed non-operatively.
- Out of 622 line placements, only 1 patient (symptomatic with pleural effusion) required chest tube intervention.
- Selective CXR protocol reduces radiation exposure and healthcare costs without compromising patient safety.
- Clinical assessment trumps routine imaging: symptoms should guide the decision to obtain post-procedural chest radiographs.
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Transcript
This is Todd Ponsky from the Journal of Pediatric Surgery doing your two-minute review. Today we're gonna review an article entitled Chest Radiograph after Fluoricoscopic guided Line Placement. No Longer Necessary. The first author is Doctor Brian Dalton and the senior author is Doctor Sean Saint Peter. The guys at Kansas City did it again, fantastic study. What they address here is do we need to be doing routine chest x-rays after every line that we place? So what they did is they decided to have a new protocol where they try not to get chest x-rays routinely after lines and then they went back retrospectively and looked at the results. They did 622 lines. 504 of those had no chest X-ray. They had no symptoms and they had no adverse outcomes. 93 patients had no symptoms but still had a chest X-ray by surgeon preference, and none of them had any adverse outcomes. There were 25 patients that had symptoms and received a chest X-ray. Of those, 4 had a pneumothorax, but they were managed non-operatively and sent home the next day. There was one patient that was symptomatic and had a pleural effusion that did require a chest tube, so out of 622 patients, only one patient required a chest tube, and that was a patient who was symptomatic. So their conclusions are you do not routinely need to get a chest x-ray after every line placement. If they become symptomatic, get a chest X-ray, and if they need a chest tube, then you can place it. We hope you enjoyed this review. We'll see you next time. Thanks.