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

Citation
Sn. Tierney et al., Cost comparison of electrocardiography versus fluoroscopy for central venous line positioning in children, J AM COLL S, 191(2), 2000, pp. 209-211
Citations number
12
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
ISSN journal
10727515 → ACNP
Volume
191
Issue
2
Year of publication
2000
Pages
209 - 211
Database
ISI
SICI code
1072-7515(200008)191:2<209:CCOEVF>2.0.ZU;2-G
Abstract
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).