Wednesday December 28, 2005
Is confirmatory chest-x-ray always necessary?

It is a standard of practice to have followup chest-x-ray following endotracheal intubation and central venous catheter insertion. But do we always absolutely need it ?. See these 2 interesting studies both comprised of 100 patients.

For endotracheal tube: Prospective study of 101 patients done at Cooper Hospital, Camden, NJ showed that the incidence of acutely significant malpositions of endotracheal tube, when performed by experienced critical care personnel, were rare (one out of 101 intubations), and may be followed by routine, rather than 'stat' chest radiographs.1

For central venous catheter (IJ): Prospective study of 100 patients done at Lenox Hill Hospital, New York showed that 98 catheters were in accurate position after uncomplicated insertion of a Triple-Lumen Catheter in the Right internal jugular vein with anterior approach and concluded that it is safe to omit the routine chest radiograph after uncomplicated insertion of a TLC and IV treatment can be initiated early. 2 (We found atleast one study in literature arguing against this work. Study of 107 patients from NIH showed 14% incidence of malpositions, and conclusion was: Chest radiographs are necessary to ensure correct internal jugular catheter position).3

References: Click to get abstract or article

1. Utility of postintubation chest radiographs in the intensive care unit - Critical Care 2000, 4:50-53
2. Is Chest Radiography Necessary After Uncomplicated Insertion of a Triple-Lumen Catheter in the Right Internal Jugular Vein, Using the Anterior Approach?* - Chest. 2005;127:220-223
3. Cannulation of the internal jugular vein: Is postprocedural chest radiography always necessary? - Critical Care Medicine: Volume 27(9) September 1999 pp 1819-1823
4. Value of postprocedural chest radiographs in the adult intensive care unit - Crit Care Med 1992; 20:1513-1518