Farrell J, Gellens M
Are routine chest x-rays required post placement of acute
hemodialysis internal jugular access?
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1406 1996
"Are routine chest x-rays required post placement of acute HD IJ
access?"
Current practice requires a CXR after central line
placement. This is both costly and time-consuming. The yield of these
routine CXR's has not previously been established.
In this retrospective review of internal jugular catheter placement
covering a 2 year period, there were 260 procedures, of which 40% were
done under ultrasound guidance. There were no occurrences of
pneumothorax, and almost all complications were related to carotid
puncture, which would not be discovered solely on CXR and which was
avoided by using ultrasound. Malposition of the line was found in 3
cases (1.42%). The authors conclude that routine CXR after internal
jugular catheter placement is not useful in the absence of clinical
suspicion of a problem.
Comment: The study is limited to the IJ position, and the
conclusions can not be extrapolated to subclavian catheters. Detail on
the nature of the clinically unsuspected malpositions would be
helpful, as the question arises as to what the cost, if any,
(morbidity, etc) would be of using malpositioned catheters. Another
related study would be to look at the value of CXR after catheter
replacement over a guide wire. (James A. Sondheimer MD, Wayne
State University, Detroit, MI)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: venous