UTILITY OF CHEST RADIOGRAPHS AFTER GUIDEWIRE EXCHANGES OF CENTRAL VENOUS CATHETERS

Objective: To determine whether chest radiographs are warranted after uncomplicated guidewire exchanges of central venous catheters in patie nts admitted to a Level I trauma intensive care unit. Design: Prospect ive study performed in two phases, Setting: Intensive care unit in a L evel I trauma center, Patients: Patients admitted to a Level I trauma center intensive care unit who required central Venous catheter guidew ire exchanges, Interventions: Criteria for uncomplicated guidewire exc hanges were established and followed, A catheter exchange checklist wa s completed at each procedure, and a chest radiograph was performed af ter each guidewire exchange, The complications followed were catheter malposition, pneumothorax, hemothorax, and cardiac tamponade, Results were reviewed after 3 mos, and a second phase of the study was initiat ed in which chest radiographs were obtained selectively and were not p erformed for uncomplicated exchanges, If obtained, subsequent radiogra phs were reviewed, and patients were followed to discharge for complic ations, Measurements and Main Results: One hundred central venous cath eter exchanges with postprocedure radiographs were evaluated in phase I, The only complication identified was one malpositioned catheter, In phase II, 100 patients were followed, Eighty-four patients did not ha ve chest radiographs performed after guidewire exchange; 69 patients h ad subsequent radiographs documenting good placement of the catheter, and 15 patients did not have a radiograph before death (n = 2) or disc harge from the hospital (n = 13), Sixteen patients had postprocedure r adiographs performed, There were no malpositioned catheters or complic ations related to guidewire exchanges, Conclusions: Chest radiographs are unwarranted after uncomplicated guidewire exchanges of central ven ous catheters in hemodynamically stable, monitored patients, Eliminati ng these radiographs will result in significant cost and time savings without adversely affecting patient outcome.