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Routine chest X-ray is not required after a low-risk central venous cannulation.

Pikwer, Andreas LU ; Bååth, Lars LU ; Perstoft, I; Davidson, B and Åkeson, Jonas LU (2009) In Acta Anaesthesiologica Scandinavica 53. p.1145-1152
Abstract
Background: Knowledge of the radiographic catheter tip position after central venous cannulation is normally not required for short-term catheter use. Detection of a possible iatrogenic pneumothorax may nevertheless justify routine post-procedure chest X-ray. Our aim was to design a clinical decision rule to select patients for radiographic evaluation after central venous cannulation. Methods: A total of 2230 catheterizations performed using external jugular, internal jugular or subclavian venous approaches during a 4-year period were included consecutively. Information on patient data and corresponding procedures was recorded prospectively. A post-procedure chest X-ray was obtained after each cannulation. Results: Thirteen cases (0.58%)... (More)
Background: Knowledge of the radiographic catheter tip position after central venous cannulation is normally not required for short-term catheter use. Detection of a possible iatrogenic pneumothorax may nevertheless justify routine post-procedure chest X-ray. Our aim was to design a clinical decision rule to select patients for radiographic evaluation after central venous cannulation. Methods: A total of 2230 catheterizations performed using external jugular, internal jugular or subclavian venous approaches during a 4-year period were included consecutively. Information on patient data and corresponding procedures was recorded prospectively. A post-procedure chest X-ray was obtained after each cannulation. Results: Thirteen cases (0.58%) of cannulation-associated pneumothorax were identified. The risk of pneumothorax after a technically difficult (1.8%) or subclavian (1.6%) cannulation was significantly higher than after cannulation not considered as difficult (0.37%) or performed using other routes (0.33%). Clinical signs of pneumothorax within 8 h of cannulation were found in all seven patients with pneumothorax requiring specific treatment. A new clinical decision rule for radiographic evaluation after central venous cannulation based on the results of the present study shows that 48% of the post-procedure chest X-rays performed in our patients were clinically redundant. Conclusion: Clinical symptoms were reported in all patients with pneumothorax requiring specific treatment. Approximately half of the post-procedure chest X-ray controls could be avoided using the proposed clinical decision rule to select patients for radiographic evaluation after central venous cannulation. A large prospective multi-centre study should be carried out to further evaluate this decision rule. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Anaesthesiologica Scandinavica
volume
53
pages
1145 - 1152
publisher
Wiley-Blackwell
external identifiers
  • wos:000269537100006
  • pmid:19422354
  • scopus:69949161480
ISSN
0001-5172
DOI
10.1111/j.1399-6576.2009.01980.x
language
English
LU publication?
yes
id
da4aebb7-19cd-4cc6-9393-cd44d03c8bd5 (old id 1412577)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19422354?dopt=Abstract
date added to LUP
2009-06-01 11:11:52
date last changed
2017-03-19 04:18:52
@article{da4aebb7-19cd-4cc6-9393-cd44d03c8bd5,
  abstract     = {Background: Knowledge of the radiographic catheter tip position after central venous cannulation is normally not required for short-term catheter use. Detection of a possible iatrogenic pneumothorax may nevertheless justify routine post-procedure chest X-ray. Our aim was to design a clinical decision rule to select patients for radiographic evaluation after central venous cannulation. Methods: A total of 2230 catheterizations performed using external jugular, internal jugular or subclavian venous approaches during a 4-year period were included consecutively. Information on patient data and corresponding procedures was recorded prospectively. A post-procedure chest X-ray was obtained after each cannulation. Results: Thirteen cases (0.58%) of cannulation-associated pneumothorax were identified. The risk of pneumothorax after a technically difficult (1.8%) or subclavian (1.6%) cannulation was significantly higher than after cannulation not considered as difficult (0.37%) or performed using other routes (0.33%). Clinical signs of pneumothorax within 8 h of cannulation were found in all seven patients with pneumothorax requiring specific treatment. A new clinical decision rule for radiographic evaluation after central venous cannulation based on the results of the present study shows that 48% of the post-procedure chest X-rays performed in our patients were clinically redundant. Conclusion: Clinical symptoms were reported in all patients with pneumothorax requiring specific treatment. Approximately half of the post-procedure chest X-ray controls could be avoided using the proposed clinical decision rule to select patients for radiographic evaluation after central venous cannulation. A large prospective multi-centre study should be carried out to further evaluate this decision rule.},
  author       = {Pikwer, Andreas and Bååth, Lars and Perstoft, I and Davidson, B and Åkeson, Jonas},
  issn         = {0001-5172},
  language     = {eng},
  pages        = {1145--1152},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {Routine chest X-ray is not required after a low-risk central venous cannulation.},
  url          = {http://dx.doi.org/10.1111/j.1399-6576.2009.01980.x},
  volume       = {53},
  year         = {2009},
}