Ja. Palesty et al., Routine chest radiographs following central venous recatheterization over a wire are not justified, AM J SURG, 176(6), 1998, pp. 618-620
BACKGROUND: Subclavian vein central venous catheterization and the subseque
nt exchange of subclavian catheters over a guidewire are frequently perform
ed procedures. We hypothesized that the policy of obtaining a routine postp
rocedure chest radiograph to confirm appropriate catheter placement and to
rule out complications after exchanging central venous catheters over a wir
e was no longer justifiable.
METHODS: A retrospective study of 295 patients with Swan-Ganz catheters (SG
C) was performed between July 1, 1994 and June 30, 1996, One hundred fourte
en of these SGCs were exchanged over a guidewire for a central venous cathe
ter (CVC). Postexchange chest radiograph and associated radiologist's repor
t, as well as age, gender, and duration of catheter placement were all reco
rded. Since July 1996, this study has been extended prospectively,
RESULTS: Of the 380 documented over-a-wire exchanges, none has resulted in
a complication, including catheter malposition.
CONCLUSION: We conclude from these data that a routine chest radiograph fol
lowing the replacement of a CVC over a guidewire is not necessary when good
clinical judgment and discrimination are used in a monitored setting. Am J
Surg. 1998;176:618-621, (C) 1998 by Excerpta Medica, Inc.