Jason Chui1, Rasha Saeed2, Luke Jakobowski2, Wanyu Wang2, Basem Eldeyasty2, Fang Zhu3, LeeAnne Fochesato2, Ronit Lavi2, Daniel Bainbridge2. 1. Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON, Canada. Electronic address: jason.chui@lhsc.on.ca. 2. Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON, Canada. 3. Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON, Canada; MEDICI, University of Western Ontario, London, ON, Canada.
Abstract
BACKGROUND: A routine chest radiograph (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. The goal of this study was to assess the value of a routine postprocedural CXR in the era of ultrasound-guided CVC insertion. METHODS: This population-based retrospective cohort study was performed to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008, and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. A logistic regression analysis was performed to examine the potential risk factors associated with these complications, and a cost analysis was conducted to evaluate the economic impact. RESULTS: Of 18,274 patients who had a CVC inserted, 6,875 patients were included. The overall incidence of pneumothorax and catheter misplacement was 0.33% (95% CI, 0.22-0.5) (23 patients) and 1.91% (95% CI, 1.61-2.26) (131 patients), respectively. The site of catheterization was the major determinant of pneumothorax and catheter misplacement; left subclavian vein catheterization was the site at a higher risk for pneumothorax (OR, 6.69 [95% CI, 2.45-18.28]; P < .001), and catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Expenditures on routine postprocedural CXR were US $105,000 to $183,000 per year at our institution. CONCLUSIONS: This study found that pneumothorax and catheter misplacement after ultrasound-guided CVC insertion were rare, and the costs of a postprocedural CXR were exceedingly high. We concluded that a routine postprocedural CXR is unnecessary and not a wise choice in our setting.
BACKGROUND: A routine chest radiograph (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. The goal of this study was to assess the value of a routine postprocedural CXR in the era of ultrasound-guided CVC insertion. METHODS: This population-based retrospective cohort study was performed to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008, and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. A logistic regression analysis was performed to examine the potential risk factors associated with these complications, and a cost analysis was conducted to evaluate the economic impact. RESULTS: Of 18,274 patients who had a CVC inserted, 6,875 patients were included. The overall incidence of pneumothorax and catheter misplacement was 0.33% (95% CI, 0.22-0.5) (23 patients) and 1.91% (95% CI, 1.61-2.26) (131 patients), respectively. The site of catheterization was the major determinant of pneumothorax and catheter misplacement; left subclavian vein catheterization was the site at a higher risk for pneumothorax (OR, 6.69 [95% CI, 2.45-18.28]; P < .001), and catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Expenditures on routine postprocedural CXR were US $105,000 to $183,000 per year at our institution. CONCLUSIONS: This study found that pneumothorax and catheter misplacement after ultrasound-guided CVC insertion were rare, and the costs of a postprocedural CXR were exceedingly high. We concluded that a routine postprocedural CXR is unnecessary and not a wise choice in our setting.
Authors: Enyo A Ablordeppey; Anne M Drewry; Daniel L Theodoro; LinLin Tian; Brian M Fuller; Richard T Griffey Journal: Shock Date: 2019-05 Impact factor: 3.454
Authors: Enyo A Ablordeppey; Adam M Koenig; Abigail R Barker; Emily E Hernandez; Suzanne M Simkovich; James G Krings; Derek S Brown; Richard T Griffey Journal: West J Emerg Med Date: 2022-09-15
Authors: Enyo A Ablordeppey; Anne M Drewry; Adam L Anderson; Diego Casali; Laura A Wallace; Deborah S Kane; LinLin Tian; Stacey L House; Brian M Fuller; Richard T Griffey; Daniel L Theodoro Journal: AEM Educ Train Date: 2020-10-13