title: Is chest radiography necessary after uncomplicated insertion of a triple-lumen catheter in the right internal jugular vein, using the anterior approach?
abstract: OBJECTIVE
  Chest radiographs are required in many institutions by protocol after the insertion of a right internal jugular vein triple-lumen catheter (TLC), even if the anterior approach is used. This study investigates whether correct placement can be predicted during insertion and whether a "routine" postprocedural chest radiograph can be safely omitted.
  
  
  METHODS
  The operators included 18 first-, second-, or third-year medical residents, 3 pulmonary fellows, and a board-certified pulmonary medicine and critical care attending, with at least 1 certified physician present during the procedure. All operators were trained in the "seven number rule."
  
  
  METHODS
  One hundred consecutive patients who required central venous access. Patients with left internal jugular vein or subclavian catheters were excluded.
  
  
  METHODS
  Single institution, medical ICU, step-down unit, and floors.
  
  
  METHODS
  Right internal jugular vein TLC insertion, anterior approach, with subsequent chest radiograph.
  
  
  RESULTS
  Eighty-eight patients had uncomplicated insertions, as defined by fewer than four sticks with a 22-gauge pathfinder needle and fewer than four slides with the 18-gauge introducer needle. Ninety-eight catheters were in accurate position, 1 catheter was in the distal superior cava vein, and 1 catheter was in an S-shaped position.
  
  
  CONCLUSIONS
  It is safe to omit the routine chest radiograph after uncomplicated insertion of a TLC. i.v. treatment can be initiated early. However, if there is any doubt about the correct position, a chest radiograph should be obtained.
authors.affiliation: Section of Pulmonary Medicine, Lenox Hill Hospital, New York, NY, USA. KLessnau@pol.net
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Lessnau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods; D002985:Clinical Protocols; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*