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Pediatric Radiology

, Volume 36, Issue 12, pp 1252–1256 | Cite as

Central venous cannulation: are routine chest radiographs necessary after B-mode and colour Doppler sonography check?

  • Cecilia LanzaEmail author
  • Marco Russo
  • Giancarlo Fabrizzi
Original Article

Abstract

Background

After the insertion of a central venous catheter, a chest radiograph is usually obtained to ensure correct positioning of the catheter tip.

Objective

To determine in a paediatric population whether B-mode and colour Doppler sonography after central venous access is useful to evaluate catheter position, thus obviating the need for a postprocedural radiograph.

Materials and methods

A prospective study of 107 consecutive central venous access procedures placed in a paediatric intensive care unit was performed. At the end of the procedure, B-mode and colour Doppler sonography were used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients.

Results

In 96 patients postprocedural B-mode and colour Doppler sonography showed colour Doppler signals within the vena cava. Among the 11 patients predicted to have a potential complication, there was one pneumothorax and ten malpositions. Chest radiography showed a total of 13 complications—1 pneumothorax and 12 malpositions. The concordance between colour Doppler sonography and chest radiography was 98.1% in the detection of catheter position; sonography had a sensitivity of 84.6% and a specificity of 100%.

Conclusions

The close concordance between B-mode and colour Doppler sonography and chest radiography justifies the more frequent use of sonography to evaluate catheter position because ionizing radiation is eliminated. Chest radiography may then be performed only when there is suspected inappropriate catheter tip position after sonography.

Keywords

Radiography Ultrasound Central venous access Children 

References

  1. 1.
    Aubaniac R (1952) L’injection intraveineuse sous-claviculaire. Presse Med 60:1656–1659Google Scholar
  2. 2.
    Wilson JN, Grow JB, Demong CV, et al (1962) Central venous pressure in optimal blood volume maintenance. Arch Surg 85:563–577PubMedGoogle Scholar
  3. 3.
    Johnson EM, Saltzman DA, Suh G, et al (1998) Complications and risks of central venous catheter placement in children. Surgery 124:911–916PubMedGoogle Scholar
  4. 4.
    Sterzel JP, Green TP, Fuhrman BP, et al (1989) Percutaneous central venous catheterization in a pediatric intensive care unit: a survival analysis of complications. Crit Care Med 17:984–988Google Scholar
  5. 5.
    Etheridge SP, Berry JM, Krabill KA, et al (1995) Echocardiographic guided internal jugular venous cannulation in children with heart disease. Arch Pediatr Adolesc Med 149:77–80PubMedGoogle Scholar
  6. 6.
    Giacoia GP (1991) Cardiac tamponade and hydrothorax as a complication of central venous parenteral nutrition in infants. J Parenter Enteral Nutr 15:110–113CrossRefGoogle Scholar
  7. 7.
    Casado-Flores J, Valdivielso-Serna A, Perez-Jurado L, et al (1991) Subclavian vein catheterization in critically ill children: analysis of 322 cannulations. Intensive Care Med 17:350–354PubMedCrossRefGoogle Scholar
  8. 8.
    Girvan DP, deVeber LL, Inwood MJ, et al (1994) Subcutaneous infusion ports in the pediatric patient with hemophilia. J Pediatr Surg 29:1220–1223PubMedCrossRefGoogle Scholar
  9. 9.
    Albanese CT, Wiener ES (1993) Venous access in pediatric oncology patients. Semin Surg Oncol 9:467–477PubMedCrossRefGoogle Scholar
  10. 10.
    Gauderer MW, Stellato TA (1985) Subclavian Broviac catheter placements. J Pediatr Surg 20:402–405PubMedCrossRefGoogle Scholar
  11. 11.
    Sznajder JI, Zveibil FR, Bitterman H, et al (1986) Central venous catheterization: failure and complication rates by three percutaneous approaches. Arch Intern Med 146:259–261PubMedCrossRefGoogle Scholar
  12. 12.
    Yerdel MA, Karayalcin K, Aras N, et al (1991) Mechanical complications of subclavian vein catheterization: a prospective study. Int Surg 76:18–22PubMedGoogle Scholar
  13. 13.
    Bernard RW, Stahl WM (1971) Subclavian vein catheterization. A prospective study. Ann Surg 173:184–190PubMedCrossRefGoogle Scholar
  14. 14.
    Yerdel MA, Karayalcin K, Anadol E (1991) Malpositioning of subclavian vein catheters in left and right sided attempts: a prospective study. Neth J Surg 43:178–180PubMedGoogle Scholar
  15. 15.
    Wiener EJ, McGuire P, Stolar CJ, et al (1992) The CCSG prospective study of venous access devices: an analysis of insertions and causes for removal. J Pediatr Surg 27:155–164PubMedCrossRefGoogle Scholar
  16. 16.
    Gladwin MT, Slonim A, Landucci DL, et al (1999) Cannulation of the internal jugular vein: is a postprocedural chest radiography always necessary? Crit Care Med 27:1819–1823PubMedCrossRefGoogle Scholar
  17. 17.
    Food and Drug Administration (1989) Precautions necessary with central venous catheters. US Government Printing Office, Washington, pp 15–16Google Scholar
  18. 18.
    Caridi JG, West JH, Stavropoulos SW, et al (2000) Internal jugular and upper extremity central venous access in interventional radiology: is a postprocedure chest radiograph necessary? AJR 174:363–366PubMedGoogle Scholar
  19. 19.
    Trerotola SO, Johnson MS, Harrid VJ, et al (1997) Outcome of tunneled hemodialysis catheters placed via the right internal jugular vein by interventional radiologist. Radiology 203:489–495PubMedGoogle Scholar
  20. 20.
    Lucey B, Varghese JC, Haslam P, et al (1999) Routine chest radiographs after central line insertion: mandatory postprocedural evaluation or unnecessary waste of resources. Cardiovasc Intervent Radiol 2:381–384CrossRefGoogle Scholar
  21. 21.
    Chang TC, Funaki B, Szymski GX (1998) Are routine chest radiographs necessary after image-guided placement of internal jugular central venous access devices. AJR 170:335–337PubMedGoogle Scholar
  22. 22.
    Guth AA (2001) Routine chest X-rays after insertion of implantable long-term venous catheters: necessary or not? Am Surg 67:26–29PubMedGoogle Scholar
  23. 23.
    Burn PR, Skewes D, King M (2001) Role of chest radiography after the insertion of a subclavian vein catheter for ambulatory chemotherapy. Can Assoc Radiol J 52:392–394PubMedGoogle Scholar
  24. 24.
    Janik JE, Cothren CC, Janik JS, et al (2003) Is a routine chest x-ray necessary for children after fluoroscopically assisted venous access? J Pediatr Surg 38:1199–1202PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Cecilia Lanza
    • 1
    Email author
  • Marco Russo
    • 2
  • Giancarlo Fabrizzi
    • 1
  1. 1.Azienda Ospedaliero-Universitaria Ospedali RiunitiPediatric Radiology Department-Presidio SalesiAnconaItaly
  2. 2.Servizio di RadiologiaOspedale Civile Engles ProfiliAnconaItaly

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