Is immediate chest radiograph necessary after central venous catheter placement in a surgical intensive care unit?

BACKGROUND: Current standard of care dictates that central Venous catheter (CVC) insertion should be followed by an immediate chest radiograph to conf irm appropriate position and rule out complications. We hypothesized that a subset of monitored intensive care unit patients exists that is at low ris k for complications and might safely have radiographic evaluation of line p lacement deferred until the next scheduled radiograph. METHODS: Data regarding patient and procedural characteristics were obtaine d prospectively for 184 CVC placed between March 1, 1998, and June 30, 1999 , Retrospective data regarding complications were obtained by chart review for an additional 174 CVC placed during the study period but for which data sheets were not completed. All procedures were followed by chest radiograp hy. RESULTS: We documented a complication rate of 9% with the vast majority (25 of 31, 81%) of complications consisting of incorrect positioning. The numb er of needle passes was greater in the group suffering pneumothorax and art erial puncture than the uncomplicated group (5.6 versus 1,9, P = 0.008). "S traightforward" operator gestalt (P = 0.04) and number of needle passes <3 (P = 0.03) were factors correlating with the absence of complications. Thes e factors had negative predictive values of 94% and 96%, respectively. CONCLUSIONS: Placement of CVC is safe in experienced hands. In monitored in tensive care unit patients who undergo a "straightforward" procedure with < 3 needle passes, chest radiograph can be safely deferred until the next sch eduled examination. (C) 2001 by Excerpta Medica, Inc.