Lucey B, Varghese J C, Haslam P, Lee M J
Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland Medical School, Beaumont Road, Dublin 9, Ireland.
Cardiovasc Intervent Radiol. 1999 Sep-Oct;22(5):381-4. doi: 10.1007/s002709900411.
To study the cost and impact on patient management of the routine performance of chest radiographs in patients undergoing imaged-guided central venous catheter insertion.
Six hundred and twenty-one catheters placed in 489 patients over a 42-month period formed the study group. Catheters were placed in the right internal jugular vein (425), left internal jugular vein (133), and subclavian veins (63). At the end of the procedure fluoroscopy was used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients.
Postprocedural chest fluoroscopy showed no evidence of pneumothorax, hemothorax, or mediastinal hematoma. Inappropriate catheter tip position or catheter kinks were noted with 90 catheters. These problems were all corrected while the patient was on the interventional table. Postprocedural chest radiographs showed no complications but proximal catheter tip migration was noted in six of 621 catheters (1%). These latter six catheters required further manipulation. The total technical and related charges for the postprocedural chest radiographs in this series were estimated at pound15,525.
Postprocedural chest radiographs after image-guided central venous catheter insertion are not routinely required. A postprocedural chest radiograph can be performed on a case-by-case basis at the discretion of the interventional radiologist.
研究在接受影像引导下中心静脉导管插入术的患者中常规进行胸部X光检查的成本及其对患者管理的影响。
在42个月期间，489例患者置入了621根导管，构成研究组。导管置入右侧颈内静脉（425根）、左侧颈内静脉（133根）和锁骨下静脉（63根）。操作结束时，使用荧光透视评估导管位置并检查有无并发症。所有患者均在术后进行了胸部X光检查。
术后胸部荧光透视未显示气胸、血胸或纵隔血肿的迹象。90根导管存在导管尖端位置不当或导管扭曲的情况。这些问题均在患者处于介入操作台上时得到纠正。术后胸部X光检查未显示并发症，但在621根导管中有6根（1%）出现导管尖端近端移位。后6根导管需要进一步处理。本系列中术后胸部X光检查的总技术及相关费用估计为15,525英镑。
影像引导下中心静脉导管插入术后通常无需常规进行胸部X光检查。介入放射科医生可根据具体情况酌情进行术后胸部X光检查。
