Routine chest roentgenogram after central venous catheter insertion is not always necessary

Sanábria, Álvaro; Henao, Carlos A.; Bonilla, Romulo; Castrillón, C Sandra; Cruz, Herman René; Ramírez, William; Navarro, Pablo; González, Mercedes; Dı́az, Abel

doi:10.1016/s0002-9610(03)00122-3

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…Multiple investigators have studied the clinical value of routine CXRs after central venous catheterization, endotracheal intubation, and chest tube placement or removal. [1][2][3][4][5][6][7][8][9][10][11][12] Others have studied the value of daily routine CXRs in a mixed ICU population, or in mechanically ventilated patients only. [13][14][15][16][17][18][19][20][21] The diagnostic and therapeutic efficacy of all these routine CXRs has been reported to be low.…”

Section: See Editorial Commentary Page 230mentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20][21] The diagnostic and therapeutic efficacy of all these routine CXRs has been reported to be low. [1][2][3][6][7][8][9]11,13,14,[16][17][18][19]21 Investigators comparing a routine CXR strategy with an on-demand CXR strategy were not able to show any difference in outcome measures. [22][23][24][25][26][27][28] Although those studies indicated that a more restrictive CXR strategy should be safe, a more recent meta-analysis by Ganapathy and colleagues 26 stated that, in those studies, the confidence intervals were wide, and the study populations were small.…”

Section: See Editorial Commentary Page 230mentioning

confidence: 99%

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Defining indications for selective chest radiography in the first 24 hours after cardiac surgery

Tolsma

Rijpstra

Rosseel

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: See Editorial Commentary Page 230mentioning

confidence: 99%

Section: See Editorial Commentary Page 230mentioning

confidence: 99%

Defining indications for selective chest radiography in the first 24 hours after cardiac surgery

Tolsma

Rijpstra

Rosseel

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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show abstract

“…Other investigators have studied the value of daily routine CXRs in a mixed ICU population or in mechanically ventilated patients only [19-28]. The diagnostic and therapeutic efficacy of these routine radiographs is now known to be low [1-3,6-10,12-15,17,19,20,22-25,28]. Studies that compared a routine CXR strategy with an ‘on-demand’ CXR strategy did not show any difference in outcome measures [29-34].…”

Section: Introductionmentioning

confidence: 99%

Significant changes in the practice of chest radiography in Dutch intensive care units: a web-based survey

et al. 2014

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BackgroundICU patients frequently undergo chest radiographs (CXRs). The diagnostic and therapeutic efficacy of routine CXRs are now known to be low, but the discussion regarding specific indications for CXRs in critically ill patients and the safety of abandoning routine CXRs is still ongoing. We performed a survey of Dutch intensivists on the current practice of chest radiography in their departments.MethodsWeb-based questionnaires, containing questions regarding ICU characteristics, ICU patients, daily CXR strategies, indications for routine CXRs and the practice of radiologic evaluation, were sent to the medical directors of all adult ICUs in the Netherlands. CXR strategies were compared between all academic and non-academic hospitals and between ICUs of different sizes. A comparison was made between the survey results obtained in 2006 and 2013.ResultsOf the 83 ICUs that were contacted, 69 (83%) responded to the survey. Only 7% of responding ICUs were currently performing daily routine CXRs for all patients, and 61% of the responding ICUs were said never to perform CXRs on a routine basis. A daily meeting with a radiologist is an established practice in 72% of the responding ICUs and is judged to be important or even essential by those ICUs. The therapeutic efficacy of routine CXRs was assumed by intensivists to be lower than 10% or to be between 10 and 20%. The efficacy of ‘on-demand’ CXRs was assumed to be between 10 and 60%. There is a consensus between intensivists to perform a routine CXR after endotracheal intubation, chest tube placement or central venous catheterization.ConclusionThe strategy of daily routine CXRs for critically ill and mechanically ventilated patients has turned from being a common practice in 2006 to a rare current practice. Other routine strategies and an ‘on-demand only’ strategy have become more popular. Intensivists still assume the value of CXRs to be higher than the efficacy that is reported in the literature.

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“…Data currently accumulating in the adult literature have suggested a postoperative chest film may not be necessary if a central line is placed under fluoroscopic guidance [1,[3][4][5][6][7][8]. A single retrospective review of a pediatric population has been published that, similar to our experience, documented a total complication rate of 1.6%, with a complication rate of 0.6% in the subgroup where fluoroscopy was used for placement of the catheters [2].…”

Section: Discussionmentioning

confidence: 55%

Chest radiograph after central line placement under fluoroscopy: utility or futility?

Keckler

Spilde

et al. 2008

Journal of Pediatric Surgery

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Background-Postoperative portable chest films are routinely performed after fluoroscopic placement of central venous catheters to evaluate positioning and to rule out significant complications (eg, pneumothorax). Emerging evidence in the literature has called this practice into question suggesting that routine postoperative chest x-ray is unnecessary. Therefore, we investigated our recent experience to examine the utility of these films, to examine the development of symptoms relative to therapeutic intervention, and to report a cost-benefit analysis.

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Routine chest roentgenogram after central venous catheter insertion is not always necessary

Cited by 9 publications

References 14 publications

Defining indications for selective chest radiography in the first 24 hours after cardiac surgery

Defining indications for selective chest radiography in the first 24 hours after cardiac surgery

Significant changes in the practice of chest radiography in Dutch intensive care units: a web-based survey

Chest radiograph after central line placement under fluoroscopy: utility or futility?

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