Dalton Brian G A, Gonzalez Katherine W, Keirsy Michael C, Rivard Douglas C, St Peter Shawn D
Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO.
Department of Radiology, Children's Mercy Hospital, Kansas City, MO.
J Pediatr Surg. 2016 Sep;51(9):1490-1. doi: 10.1016/j.jpedsurg.2016.02.003. Epub 2016 Feb 10.
Historically, a chest radiograph was obtained after central line placement in the operating room. Recent retrospective studies have questioned the need for this radiograph. The prevailing current practice at our center is to order chest radiograph only for symptomatic patients. This study examines the outcomes of selective chest radiography after fluoroscopic guided central line placement.
After obtaining institutional review board approval, a single institution retrospective chart review of patients undergoing central venous catheter placement by the pediatric surgery or interventional radiology service between January 2010 and July 2014 was performed. Outcome measures included CXR within 24h of catheter placement, reason for chest radiograph, complication, and complication requiring intervention.
In the study population 622 catheters were placed under fluoroscopy. A chest radiograph was performed in 118 (19%) patients within 24h of the line placement with 25 (4%) of these patients being symptomatic in the recovery room. One patient required chest tube for shortness of breath and pleural effusion. Four symptomatic patients (0.6%) were found to have a pneumothorax, none of which required chest tube placement. There were no re-operations because of mal-position of the catheter. In the 504 patients with no postoperative chest x-ray, there were no adverse outcomes. At our institution the current average charge of a chest radiograph is $283, thus we produced savings of $142,632 for the study period without adverse events.
After placement of central venous catheter under fluoroscopic guidance, a chest radiograph is unlikely to be helpful in an asymptomatic patient.
过去，在手术室放置中心静脉导管后会进行胸部X线检查。近期的回顾性研究对这种X线检查的必要性提出了质疑。目前我们中心的普遍做法是仅对有症状的患者开具胸部X线检查医嘱。本研究探讨了在透视引导下放置中心静脉导管后进行选择性胸部X线检查的结果。
在获得机构审查委员会批准后，对2010年1月至2014年7月间由小儿外科或介入放射科进行中心静脉导管置入的患者进行了单机构回顾性病历审查。观察指标包括导管置入后24小时内的胸部X线检查、进行胸部X线检查的原因、并发症以及需要干预的并发症。
在研究人群中，622根导管在透视下置入。118例（19%）患者在置管后24小时内进行了胸部X线检查，其中25例（4%）患者在恢复室有症状。1例患者因呼吸急促和胸腔积液需要放置胸管。4例有症状的患者（0.6%）被发现有气胸，其中无一例需要放置胸管。没有因导管位置不当而进行再次手术的情况。在504例未进行术后胸部X线检查的患者中，没有出现不良后果。在我们机构，目前一张胸部X线检查的平均费用为283美元，因此在研究期间我们节省了142,632美元且无不良事件发生。
在透视引导下放置中心静脉导管后，胸部X线检查对无症状患者可能并无帮助。
