Frassinelli P, Pasquale M D, Cipolle M D, Rhodes M
Department of Surgery, Lehigh Valley Hospital, Allentown, PA, USA.
Crit Care Med. 1998 Mar;26(3):611-5. doi: 10.1097/00003246-199803000-00040.
To determine whether chest radiographs are warranted after uncomplicated guidewire exchanges of central venous catheters in patients admitted to a Level I trauma intensive care unit.
Prospective study performed in two phases.
Intensive care unit in a Level I trauma center.
Patients admitted to a Level I trauma center intensive care unit who required central venous catheter guidewire exchanges.
Criteria for uncomplicated guidewire exchanges were established and followed. A catheter exchange checklist was completed at each procedure, and a chest radiograph was performed after each guidewire exchange. The complications followed were catheter malposition, pneumothorax, hemothorax, and cardiac tamponade. Results were reviewed after 3 mos, and a second phase of the study was initiated in which chest radiographs were obtained selectively and were not performed for uncomplicated exchanges. If obtained, subsequent radiographs were reviewed, and patients were followed to discharge for complications.
One hundred central venous catheter exchanges with postprocedure radiographs were evaluated in phase I. The only complication identified was one malpositioned catheter. In phase II, 110 patients were followed. Eighty-four patients did not have chest radiographs performed after guidewire exchange; 69 patients had subsequent radiographs documenting good placement of the catheter, and 15 patients did not have a radiograph before death (n = 2) or discharge from the hospital (n = 13). Sixteen patients had postprocedure radiographs performed. There were no malpositioned catheters or complications related to guidewire exchanges.
Chest radiographs are unwarranted after uncomplicated guidewire exchanges of central venous catheters in hemodynamically stable, monitored patients. Eliminating these radiographs will result in significant cost and time savings without adversely affecting patient outcome.
确定在一级创伤重症监护病房住院的患者进行中心静脉导管简单导丝更换后是否需要进行胸部X光检查。
分两个阶段进行的前瞻性研究。
一级创伤中心的重症监护病房。
入住一级创伤中心重症监护病房且需要更换中心静脉导管导丝的患者。
制定并遵循简单导丝更换的标准。每次操作时填写导管更换检查表，每次导丝更换后进行胸部X光检查。随后追踪的并发症包括导管位置不当、气胸、血胸和心脏压塞。3个月后复查结果，并启动研究的第二阶段，即选择性地进行胸部X光检查，对于简单更换不进行检查。如果进行了检查，对后续的X光片进行复查，并追踪患者直至出院以了解并发症情况。
在第一阶段评估了100次更换中心静脉导管并进行术后X光检查的情况。唯一发现的并发症是一根导管位置不当。在第二阶段，对110名患者进行了追踪。84名患者在导丝更换后未进行胸部X光检查；69名患者随后的X光片显示导管位置良好，15名患者在死亡（n = 2）或出院（n = 13）前未进行X光检查。16名患者进行了术后X光检查。没有出现导管位置不当或与导丝更换相关的并发症。
对于血流动力学稳定且接受监测的患者，在进行中心静脉导管简单导丝更换后无需进行胸部X光检查。取消这些X光检查将显著节省成本和时间，且不会对患者预后产生不利影响。
