Utility of chest radiographs after guidewire exchanges of central venous catheters.
OBJECTIVE
To determine whether chest radiographs are warranted after uncomplicated guidewire exchanges of central venous catheters in patients admitted to a Level I trauma intensive care unit.


METHODS
Prospective study performed in two phases.


METHODS
Intensive care unit in a Level I trauma center.


METHODS
Patients admitted to a Level I trauma center intensive care unit who required central venous catheter guidewire exchanges.


METHODS
Criteria for uncomplicated guidewire exchanges were established and followed. A catheter exchange checklist was completed at each procedure, and a chest radiograph was performed after each guidewire exchange. The complications followed were catheter malposition, pneumothorax, hemothorax, and cardiac tamponade. Results were reviewed after 3 mos, and a second phase of the study was initiated in which chest radiographs were obtained selectively and were not performed for uncomplicated exchanges. If obtained, subsequent radiographs were reviewed, and patients were followed to discharge for complications.


RESULTS
One hundred central venous catheter exchanges with postprocedure radiographs were evaluated in phase I. The only complication identified was one malpositioned catheter. In phase II, 110 patients were followed. Eighty-four patients did not have chest radiographs performed after guidewire exchange; 69 patients had subsequent radiographs documenting good placement of the catheter, and 15 patients did not have a radiograph before death (n = 2) or discharge from the hospital (n = 13). Sixteen patients had postprocedure radiographs performed. There were no malpositioned catheters or complications related to guidewire exchanges.


CONCLUSIONS
Chest radiographs are unwarranted after uncomplicated guidewire exchanges of central venous catheters in hemodynamically stable, monitored patients. Eliminating these radiographs will result in significant cost and time savings without adversely affecting patient outcome.
Frassinelli
P
P
Department of Surgery, Lehigh Valley Hospital, Allentown, PA, USA.
Pasquale
M D
MD
Cipolle
M D
MD
Rhodes
M
M
D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D011446:Prospective Studies; D013902:Radiography, Thoracic