Routine chest radiographs after insertion of silicone internal jugular venous hemodialysis catheters are neither necessary nor cost effective

Background: Postprocedural chest radiographs (pCXRs) to exclude pneumothora x and confirm catheter tip position are routinely performed after placement of cuffed silicone hemodialysis catheters. Using a modified technique for the insertion of these catheters into the internal jugular vein (IJV), we s ought to stud the necessity and cost effectiveness of pCXRs. Methods: Based upon an initial review of patient records and/or pCXRs (data presented herein), it appeared as if our technique was safe and resulted i n a very low rate of catheter tip malposition. We therefore performed a pro spective study evaluating all patients who underwent this procedure for the incidence of pneumothorax, catheter tip position, and function at the init ial dialysis treatment. All procedures were performed in the operating room by two surgeons using a modified technique which has been previously repor ted. Results: In the initial review, the records of 338 procedures were reviewed for pneumothorax. In the subsequent 576 procedures (retrospective, n = 138 ; prospective, n = 438), the pCXRs were evaluated for pneumothorax, cathete r tip position, and function at the initial dialysis treatment. In the tota l cohort of 914 procedures, the incidence of pneumothorax was 0% (0.0-0.5% risk, 99% CI). In the 576 pCXRs evaluated for tip position, 5 catheter tips (0.9%) were found to be malpositioned (0.0-1.9% risk, 99% CI), but 2/5 fun ctioned for dialysis without repositioning. Three additional correctly posi tioned catheters failed to function for the initial dialysis, giving a 99% (570/576) rate of initial function (0.0-2.1% risk of inadequate function, 9 9% CI). Besides tip malposition, no other technical complications were diag nosed on pCXR. Using the 1998 Medicare reimbursement schedule, we anticipat e a savings of $22,810 per year for our institution at our current rate of approximately 150 procedures per year. Conclusions: We believe that our technique is safe and effective, and there fore conclude that a pCXR id not required after this procedure. Furthermore , elimination of the pCXR will result in a cost savings.