Bedside ultrasound as an alternative to chest radiograph in detecting complications associated with central venous catheter placement: a retrospective cohort study

Background: Current practice in most institutions includes a routine post-procedural chest radiograph after central venous catheter (CVC) placement. After the introduction of ultrasonography guidance, the utility of obtaining such imaging was called into question. The goal of this study was to determine whether the use of bedside ultrasound is inferior to chest radiograph in detecting post-procedural complications and to assess the cost-effectiveness of these studies.Methods: This was a retrospective cohort study involving patients in the intensive care unit who underwent above diaphragm CVC placement in one community hospital between April 5, 2018 – January 21, 2019. Before August 17, 2018 post-procedure chest radiograph was routinely obtained (pre-intervention group), and after this date it was avoided and ultrasound was used instead (post-intervention group). The incidence of pneumothorax and catheter misplacement was compared between the two groups and a cost analysis was conducted.Results: The final sample included 264 patients, 132 in each group. The incidence of pneumothorax was 1.1% (1.5% pre-intervention vs. 0.8% post-intervention, P=1.00). The incidence of line malposition was 6.4% (6.8% pre-intervention vs. 6.1% post-intervention, P=0.70), with the most common site being left internal jugular vein (LIJ). The mean number of chest radiographs per patient per hospital stay decreased from 4.7 pre-intervention to 3.5 post-intervention, P=0.002. The total number of chest radiographs performed during the study period decreased from 614 to 459. This difference equated to the savings of approximately $37,820.Conclusions: This study showed that routine post-procedural chest radiograph provides no benefit to the patient if post-procedure ultrasound is utilized. Catheter malposition and pneumothorax are rare. It is also associated with additional health risks and financial costs. In agreement with other similar studies, we recommend against this practice. This study supports the inclusion of post-procedure ultrasound in CVC placement protocol.