title: Cost comparison of electrocardiography versus fluoroscopy for central venous line positioning in children.
abstract: BACKGROUND
  Although most central venous lines in children are positioned using fluoroscopy, electrocardiography (ECG) has been shown to be accurate, and avoids unnecessary radiation exposure. We studied whether ECG may also have cost advantages.
  
  
  METHODS
  All ports and Hickman/Broviac catheters placed during a 2.5-year period were reviewed. Two surgeons routinely used fluoroscopy, and two used ECG. Costs included surgeon and anesthesia fees, operating room use, and fluoroscopy equipment and personnel.
  
  
  RESULTS
  There were 287 cases with sufficient data to be included in the study (167 fluoroscopy and 120 ECG). In the ECG group, 12 (10%) were converted to fluoroscopy because an adequate tracing could not be obtained, but they were kept in the ECG group for data analysis. The groups were similar with regard to age, gender, indication, previous catheters, and intraoperative or postoperative complications. Time for surgical placement of the line was not significantly affected by the positioning technique. Ports placed using ECG were less costly than those placed fluoroscopically ($2,880+/-408 versus $3,595+/-357, p<0.001), and the same was true for tunneled external catheters ($2,249 +/- 435 versus $2,923+/-350, p<0.001).
  
  
  CONCLUSIONS
  The ECG technique was less costly than fluoroscopy, despite a 10% conversion rate. At our center, the savings were approximately $700 per procedure. Because operating room time used is similar, the additional cost of fluoroscopy can be attributed to the need for x-ray equipment and personnel.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Tierney
authors.forename: J
authors.initials: J
authors.lastname: Katke
authors.forename: J C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D000776:Anesthesiology / Q000191:economics; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000145:classification / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000145:classification; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017046:Cost Savings; D003365:Costs and Cost Analysis; D004562:Electrocardiography / Q000191:economics*; D005251:Fees, Medical; D005260:Female; D005471:Fluoroscopy / Q000191:economics* / Q000295:instrumentation; D013502:General Surgery / Q000191:economics; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D009873:Operating Rooms / Q000191:economics; D010564:Personnel, Hospital / Q000191:economics; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors