Cost comparison of electrocardiography versus fluoroscopy for central venous line positioning in children

Background: Although most central venous lines in children are positioned u sing fluoroscopy, electrocardiography (ECG) has been shown to be accurate, and avoids unnecessary radiation exposure. We studied whether ECG may also have cost advantages. Study Design: All ports and Hickman/Broviac catheters placed during a 2.5-y ear period were reviewed. Two surgeons routinely used fluoroscopy, and two used EGG. Costs included surgeon and anesthesia fees, operating room use, a nd fluoroscopy equipment and personnel. Results: There were 287 cases with sufficient data to be included in the st udy (167 fluoroscopy and 120 EGG). In the ECG group, 12 (10%) were converte d to fluoroscopy because an adequate tracing could not be obtained, but the y were kept in the ECG group for data analysis. The groups were similar wit h regard to age, gender, indication, previous catheters, and intraoperative or postoperative complications. Time for surgical placement of the line wa s not significantly affected by the positioning technique. Ports placed usi ng ECG were less costly than those placed fluoroscopically ($2,880 +/- 408 versus $3,595 +/- 357, p < 0.001), and the same was true for tunneled exter nal catheters ($2,249 +/- 435 versus $2,923 +/- 350, p < 0.001). Conclusions: The ECG technique was less costly than fluoroscopy, despite a 10% conversion rate. At our center, the savings were approximately $700 per procedure. Because operating room time used is similar, the additional cos t of fluoroscopy can be attributed to the need for x-ray equipment and pers onnel. (J Am Coll Surg 2000;191:209-211. (C) 2000 by the American College o f Surgeons).