Are routine chest radiographs needed after fluoroscopically guided percutaneous insertion of central venous catheters in children?
Current guidelines for children still mandate routine postprocedural chest x-ray to confirm placement and detect complications. This is in spite of the risk of unnecessary exposure to radiation, the additional stress to children and their parents, and the cost of this practice. We studied the impact and cost-effectiveness of this practice on the management of children after percutaneous fluoroscopically guided central venous catheter (CVC) insertions.


METHODS
A retrospective review of children who underwent percutaneous fluoroscopically guided CVC insertions between January 2000 and December 2005. Only patients with reported postprocedural radiographs in the electronic database were included, and we referred to the medical notes when the report indicated a complication.


RESULTS
Two hundred eighty consecutive patients aged between 4 and 16 years were identified. Two hundred seventy-eight (99.3%) of the reports indicated absence of complications, whereas only 2 reports (0.7%) indicated any form of complications. Of the 2 complications detected, 1 was an asymptomatic pneumothorax, and the other was a slight kink in the line; on review of the medical notes, both lines were fully functional and neither required treatment.


CONCLUSIONS
After percutaneous fluoroscopically guided CVC insertions and in the absence of clinical indications, the use of routine postprocedural radiographs in children cannot be justified and is not cost-effective.
Adwan
Hussamuddin
H
Department of Paediatric Surgery, St George's Hospital, SW17 0QT London, UK.
Gordon
Hannah
H
Nicholls
Eric
E
D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods; D013902:Radiography, Thoracic / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D006113:United Kingdom; D019564:Unnecessary Procedures / Q000191:economics*