Routine chest radiographs after central line insertion: Mandatory postprocedural evaluation or unnecessary waste of resources?

Purpose: To study the cost and impact on patient management of the routine performance of chest radiographs in patients undergoing imaged-guided centr al venous catheter insertion. Methods: Six hundred and twenty-one catheters placed in 489 patients over a 42-month period formed the study group. Catheters were placed in the right internal jugular vein (425), left internal jugular vein (133), and subclav ian veins (63). At the end of the procedure fluoroscopy was used to assess catheter position and check for complications. A postprocedural chess radio graph was obtained in all patients. Results: Postprocedural chest fluoroscopy showed no evidence of pneumothora x, hemothorax, or mediastinal hematoma. Inappropriate catheter tip position or catheter kinks were noted with 90 catheters, These problems were all co rrected while the patient was on the interventional table. Postprocedural c hest radiographs showed no complications but proximal catheter tip migratio n was noted in six of 621 catheters (1 %). These latter six catheters requi red further manipulation. The total technical and related charges for the p ostprocedural chest radiographs in this series were estimated at pound 15,5 25. Conclusion: Postprocedural chest radiographs after image-guided central ven ous catheter insertion are not routinely required. A postprocedural chest r adiograph can be performed on a case-by-case basis at the discretion of the interventional radiologist.