Routine chest X-ray is not required after a low-risk central venous cannulation.
BACKGROUND
Knowledge of the radiographic catheter tip position after central venous cannulation is normally not required for short-term catheter use. Detection of a possible iatrogenic pneumothorax may nevertheless justify routine post-procedure chest X-ray. Our aim was to design a clinical decision rule to select patients for radiographic evaluation after central venous cannulation.


METHODS
A total of 2230 catheterizations performed using external jugular, internal jugular or subclavian venous approaches during a 4-year period were included consecutively. Information on patient data and corresponding procedures was recorded prospectively. A post-procedure chest X-ray was obtained after each cannulation.


RESULTS
Thirteen cases (0.58%) of cannulation-associated pneumothorax were identified. The risk of pneumothorax after a technically difficult (1.8%) or subclavian (1.6%) cannulation was significantly higher than after cannulation not considered as difficult (0.37%) or performed using other routes (0.33%). Clinical signs of pneumothorax within 8 h of cannulation were found in all seven patients with pneumothorax requiring specific treatment. A new clinical decision rule for radiographic evaluation after central venous cannulation based on the results of the present study shows that 48% of the post-procedure chest X-rays performed in our patients were clinically redundant.


CONCLUSIONS
Clinical symptoms were reported in all patients with pneumothorax requiring specific treatment. Approximately half of the post-procedure chest X-ray controls could be avoided using the proposed clinical decision rule to select patients for radiographic evaluation after central venous cannulation. A large prospective multi-centre study should be carried out to further evaluate this decision rule.
Department of Anaesthesiology and Intensive Care Medicine, Malmö University Hospital, Lund University, Malmö, Sweden. andreas.pikwer@med.lu.se
A
A
Pikwer
L
L
Bååth
I
I
Perstoft
B
B
Davidson
J
J
Akeson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000191:economics; D003365:Costs and Cost Analysis; D003657:Decision Making; D003955:Diagnostic Tests, Routine; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000453:epidemiology; D013902:Radiography, Thoracic / Q000191:economics; D012306:Risk; D013350:Subclavian Vein; D055815:Young Adult