title: Routine chest radiographs after central line insertion: mandatory postprocedural evaluation or unnecessary waste of resources?
abstract: OBJECTIVE
  To study the cost and impact on patient management of the routine performance of chest radiographs in patients undergoing imaged-guided central venous catheter insertion.
  
  
  METHODS
  Six hundred and twenty-one catheters placed in 489 patients over a 42-month period formed the study group. Catheters were placed in the right internal jugular vein (425), left internal jugular vein (133), and subclavian veins (63). At the end of the procedure fluoroscopy was used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients.
  
  
  RESULTS
  Postprocedural chest fluoroscopy showed no evidence of pneumothorax, hemothorax, or mediastinal hematoma. Inappropriate catheter tip position or catheter kinks were noted with 90 catheters. These problems were all corrected while the patient was on the interventional table. Postprocedural chest radiographs showed no complications but proximal catheter tip migration was noted in six of 621 catheters (1%). These latter six catheters required further manipulation. The total technical and related charges for the postprocedural chest radiographs in this series were estimated at pound15,525.
  
  
  CONCLUSIONS
  Postprocedural chest radiographs after image-guided central venous catheter insertion are not routinely required. A postprocedural chest radiograph can be performed on a case-by-case basis at the discretion of the interventional radiologist.
authors.affiliation: Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland Medical School, Beaumont Road, Dublin 9, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Lucey
authors.forename: J C
authors.initials: JC
authors.lastname: Varghese
authors.forename: P
authors.initials: P
authors.lastname: Haslam
authors.forename: M J
authors.initials: MJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous; D003365:Costs and Cost Analysis; D005260:Female; D005471:Fluoroscopy / Q000191:economics; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000191:economics*; D015642:Radiology, Interventional / Q000191:economics*; D012189:Retrospective Studies; D013350:Subclavian Vein