Pneumothorax and catheter misplacement after ultrasound-guided central venous catheter (CVC) insertion are rare and thus do not justify post-procedural chest X-ray (CXR), according to a study published in the July issue of CHEST.

A routine chest radiograph (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. The goal of this study was to assess the value of a routine postprocedural CXR in the era of ultrasound-guided CVC insertion.

This population-based retrospective cohort study was performed to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008, and December 31, 2015.

Jason Chui, M.B.Ch.B., from the University of Western Ontario in London, Canada, and colleagues reviewed the records of 18,274 adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008, and Dec. 31, 2015. The authors sought to determine the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion.

Ultrasound-guided CVC insertion

"We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. A logistic regression analysis was performed to examine the potential risk factors associated with these complications, and a cost analysis was conducted to evaluate the economic impact," said Chui.

Based on the 6,875 patients included in the analysis, the researchers found that the overall incidence of pneumothorax and catheter misplacement was 0.33 and 1.91 percent, respectively.

The major determinant of pneumothorax and catheter misplacement was the site of catheterization, with left subclavian vein catheterization having a higher risk for pneumothorax (odds ratio, 6.69).

Catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Routine post-procedural CXR expenditures were $105,000 to $183,000 per year. "A routine post-procedural CXR is unnecessary and not choosing-wisely in our setting," the authors noted.

This study found that pneumothorax and catheter misplacement after ultrasound-guided CVC insertion were rare, and the costs of a postprocedural CXR were exceedingly high. We concluded that a routine postprocedural CXR is unnecessary and not a wise choice in our setting.