THE FUTILITY OF CHEST ROENTGENOGRAMS FOLLOWING ROUTINE CENTRAL VENOUSLINE CHANGES

OBJECTIVE: TO demonstrate chest roentgenograms after central venous li ne changes over a guidewire delay the use of the central lines and inc reases charges with no change of morbidity or the rate of complication . METHODS: Retrospective study using the Surgical Intensive Care datab ase followed by a nonrandomized, prospective study of central venous l ine changes, The total time from the catheter change until chest radio graph confirmation and an analysis of charges was done. RESULTS: The r etrospective study of 1,201 central line changes demonstrated no pneum othorax and two central lines malpositioned, The prospective study of 100 patients demonstrated no pneumothorax and one catheter malposition ed. The average time from completion of the central line change until the radiographic confirmation was 60.2 minutes. The charge for the che st x-ray film was $156, CONCLUSIONS: The combined studies composed of 1,301 patients demonstrated no pneumothorax and three malpositioned ca theters, This study demonstrates that radiographic confirmation of cen tral venous line placement after routine line change is of no benefit as the malpositioned catheters caused no morbidity, produces significa nt delays and increases medical charges to the patient. Extrapolation predicts an annual reduction of $46,800 in the Vanderbilt Surgical Int ensive Care Unit. (C) 1998 by Excerpta Medica, Inc.