Vascular Access Conversation - IVUPDATE Podcast from IVTEAM

"Our primary hypothesis is that confirmation of catheter tip position by chest radiograph is not associated with increased catheter duration" Pereira et al (2022).
Optimal central venous catheter tip position

Abstract:

Background: Central venous cannulation provides venous access in different settings. Multiple guidelines and checklists still recommend confirmation of central venous catheter (CVC) tip position using a chest radiograph. The rationale is to detect and prevent complications thus optimizing CVC placement. Our primary hypothesis is that confirmation of catheter tip position by chest radiograph is not associated with increased catheter duration.

Methods: A retrospective cohort study was conducted with 921 patients included. Demographic, procedure and catheter data was obtained from adult patients that placed a CVC in the operating room. The catheter tip was independently classified as “optimal” or “malpositioned” independently by two researchers.

Results: Data from 921 CVC placements was collected. Patients who had a post-procedure chest radiograph (n=682, 74.0%) differed from those who did not in terms of co-morbidities (p=0.030), indication for CVC (p=0.023), duration of placement (p<0.001), number of punctured veins (p=0.036) and use of ultrasound (p<0.001). There was substantial agreement between researchers when classifying CVC tip as "optimal" or "malpositioned" (κ=0.632, p<0.001). No statistically significant difference was found between duration or complications of "optimal" CVCs compared to unknown tip/"malpositioned" CVCs. This study showed a 99% rate of clinically redundant chest radiographs according to Pikwer's criteria for radiographic examination.

Conclusion: No difference was found regarding catheter duration or complications when comparing “optimal” and unknown/”malpositioned” tip. This study illustrates some consequences of post-procedure radiographs and reinforces that the risks/benefits should be weighed and that chest radiograph should not be done by routine.

Reference:

Pereira R, Seixas F, Almeida J, Gonçalves L, Madeira I, Costa A. “Optimal” Central Venous Catheter Tip Position Does Not Increase Catheter Duration: A Retrospective Cohort Study. Cureus. 2022 Dec 17;14(12):e32627. doi: 10.7759/cureus.32627. PMID: 36660530; PMCID: PMC9845532.