title: Chest radiograph after central line placement under fluoroscopy: utility or futility?
abstract: BACKGROUND
  Postoperative portable chest films are routinely performed after fluoroscopic placement of central venous catheters to evaluate positioning and to rule out significant complications (eg, pneumothorax). Emerging evidence in the literature has called this practice into question suggesting that routine postoperative chest x-ray is unnecessary. Therefore, we investigated our recent experience to examine the utility of these films, to examine the development of symptoms relative to therapeutic intervention, and to report a cost-benefit analysis.
  
  
  METHODS
  After obtaining institutional review board approval, all charts of patients undergoing central venous catheter placement from January 2004 to December 2005 at our institution were reviewed. Outcome measures included whether or not there was a complication and whether or not that complication required an intervention. Peripherally inserted central catheters were not included.
  
  
  RESULTS
  In the study population, 237 catheters were placed in the operating room. There were two complications, both pneumothoraces (0.085%). One patient required tube thoracostomy, whereas the other was asymptomatic and the pneumothorax resolved spontaneously. Fourteen patients had no postoperative chest film without adverse consequences. Total cost for portable chest films was $56,196.
  
  
  CONCLUSIONS
  For catheters placed under fluoroscopic guidance, postoperative chest films in asymptomatic patients add unnecessary cost. For this reason, we feel discontinuation of postoperative chest films in asymptomatic patients undergoing catheter placement with fluoroscopy is justifiable.
authors.affiliation: Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Keckler
authors.forename: Troy L
authors.initials: TL
authors.lastname: Spilde
authors.forename: Brian
authors.initials: B
authors.lastname: Ho
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005471:Fluoroscopy / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D013902:Radiography, Thoracic / Q000191:economics*; D012189:Retrospective Studies; D014481:United States