Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value

Cunningham, Aaron J.; Haag, Meredith B.; McClellan, Kristen; Krishnaswami, Sanjay; Hamilton, Nicholas A.

doi:10.1016/j.jss.2019.10.019

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…In our study, we showed that postoperative CXR resulted in no change in the management of any patient after US-guided central line placement. This is a strong evidence that this exam could be omitted, as previously suggested by others 5,10,23 . In addition, intracardiac tip positioning determined by CXR was reported in 4 cases (in 3 cases IF did not prevent this mispositioning), but in all these patients the central line was maintained and used fully, with no record of complications.…”

Section: Discussionsupporting

confidence: 78%

Ultrasound-guided central line insertion in children: how much radiation is really needed?

Castro¹,

Lima²,

Oliveira³

2020

Preprint

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Background: A recent survey revealed that most pediatric surgeons use intraoperative fluoroscopy and routine postoperative chest radiography for catheter tip location in central line insertion. The aim of this study is to review all cases of ultrasoundguided central line insertion at a tertiary pediatric center and to evaluate the role of intraoperative fluoroscopy and postoperative chest radiography. Procedure: Retrospective data analysis of children submitted to percutaneous central line insertion under ultrasound control over a 2-year period. Data collected included: age, indication for central venous access, catheter type, usage of intraoperative fluoroscopy and postoperative chest radiography usage, complications, and whether chest radiography dictated any catheter-related intervention. Results: Fifty-five long-term central lines were successfully established. All patients had the catheter tip position confirmed either by intraoperative fluoroscopy (96%), chest radiography (85%) or both (82%). Catheter tip overlying the cardiac silhouette (right atrium) on chest radiography was reported in 4 cases; these findings led to no change in catheter positioning or other catheter-related intervention. There were no catheter-related complications. Conclusions: Percutaneous central line insertion under US-control was safe and effective. Postoperative chest radiography did not dictate any modification of catheter tip positioning after central line placement with ultrasound and fluoroscopic control, thus should not be used routinely.

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Section: Discussionsupporting

confidence: 78%

Ultrasound-guided central line insertion in children: how much radiation is really needed?

Castro¹,

Lima²,

Oliveira³

2020

Preprint

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“…This is consistent with the recommendation of Cunningham et al that routine chest radiographs are dispensable after image-guided CVC placement. 10 However, it should be noted that the present cohort only included children who had undergone cardiac surgery and were fitted with chest drains as a result of the surgery; therefore, no pneumothorax was visible on the postoperative radiograph.…”

Section: Discussionmentioning

confidence: 95%

“…However, if one analyzes the anatomy, namely, the transition of the superior vena cava into the right atrium, it becomes apparent that the actual optimal area is significantly lower than that of the carina trachea 10 . Considering this, the authors concluded that even a median depth of 14 mm, which is related to the distance to the carina, of the catheters usually classified to date as too caudal was still within the optimal range.…”

Section: Discussionmentioning

confidence: 99%

Central venous catheter tip positioning using ultrasound in pediatric patients—A prospective observational study

Neumann,

Breil,

Schild

et al. 2024

Pediatric Anesthesia

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BackgroundIn children, central venous catheter (CVC) placement is usually performed under ultrasound guidance for optimal visualization of vessels and reduction of puncture‐related complications. Nevertheless, in many cases, additional radiographic examinations are performed to check the position of the catheter tip.AimThe primary objective of this observational feasibility study was to determine the number of ultrasound‐guided central venous catheter tips that can be identified in a subsequent position check using ultrasonography. Furthermore, we investigated the optimal ultrasound window, time expenditure, and success rate concerning puncture attempts and side effects. In addition, we compared the calculated and real insertion depths and analyzed the position of the catheter tip on postoperative radiographs with the tracheal bifurcation as a traditional landmark.MethodsNinety children with congenital heart defects who required a central venous line for cardiac surgery were included in this single‐center study. After the insertion of the catheter, the optimal position of its tip was controlled using one of four predefined ultrasound windows. A chest radiograph was obtained postoperatively in accordance with hospital standards to check the catheter tip position determined by ultrasonography.ResultsThe children had a median (IQR) age of 11.5 (4.0, 58.8) months and a mean (SD) BMI of 15.3 (2.91) kg/m2 Ultrasound visualization of the catheter tip was successful in 86/90 (95.6%) children (95% confidence interval [CI]: 91.3%, 99.8%). Postoperative radiographic examination showed that the catheter tip was in the desired position in 94.4% (95% CI: 89.7%, 99.2%) of the cases. None of the children needed the catheter tip position being corrected based on chest radiography.ConclusionAdditional radiation exposure after the placement of central venous catheters can be avoided with the correct interpretation of standardized ultrasound windows, especially in vulnerable children with cardiac disease.

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“…The historical standard of requesting a CXR after CVC insertion has been questioned, especially when US scan guides the procedure 3 . Pediatric studies 4,5 confirmed a low likelihood of complications in CVC placement with the aid of US guide and intraprocedural methods of tip location and therefore highlight the redundancy and futility of CXR. Despite this, the practice of routine postoperative CXR persists, as highlighted also in our survey.…”

Section: Type Of Hospital N % Years Of Experience In Cvc Insertion ...mentioning

confidence: 99%

A worldwide survey on the variability in checking the tip position of pediatric central venous catheter

Camporesi

Diotto

Pederiva

2023

Pediatric Anesthesia

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Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value

Cited by 6 publications

References 17 publications

Ultrasound-guided central line insertion in children: how much radiation is really needed?

Ultrasound-guided central line insertion in children: how much radiation is really needed?

Central venous catheter tip positioning using ultrasound in pediatric patients—A prospective observational study

A worldwide survey on the variability in checking the tip position of pediatric central venous catheter

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