In a retrospective chart review in a large teaching hospital system, the overall rate of clinically relevant complications detected on chest radiographs following US-guided right internal jugular vein catheterization is exceedingly low. A routine chest radiograph after this common procedure is an unnecessary use of resources and may delay resuscitation of critically ill patients [38]. In 200 central line placements for Whipple procedures, 198 lines were placed in the right internal jugular and 2 were placed in the subclavian [39]. No cases of pneumothorax or hemothorax were identified, and 15.3% of CVCs were improperly positioned. Only one (0.5%) of these was deemed clinically significant and repositioned after the chest radiograph was performed. They concluded that routine chest radiographs consume valuable time and resources and rarely affect management. Selection should be guided by clinical factors [39]. Swan-Ganz Catheter Previously mentioned studies incorporated the position and potential complications of Swan-Ganz catheter placements shown on chest radiographs obtained immediately postprocedure. The majority of complications, which occur in approximately 10% of catheter insertions, are minor and require catheter repositioning [24,26,29,40]. The pneumothorax rate was approximately 2% [26,40]. Central Venous Catheter In a prospective, blinded, observational study of 210 consecutive patients undergoing emergency central venous catheterization, US was compared with chest radiography to verify the correct CVC placement and to identify mechanical complications; there was a high correlation between these two modalities in identifying possible malpositioning of the catheter. However, the less time required to perform US allows earlier use of the catheter for the administration of acute therapies that can be lifesaving for critically ill patients [45]. Several studies demonstrated that LUS can reduce CVC insertion-to-use time and improve patient safety [46-48].
Intensive Care Unit Patients. In a retrospective chart review in a large teaching hospital system, the overall rate of clinically relevant complications detected on chest radiographs following US-guided right internal jugular vein catheterization is exceedingly low. A routine chest radiograph after this common procedure is an unnecessary use of resources and may delay resuscitation of critically ill patients [38]. In 200 central line placements for Whipple procedures, 198 lines were placed in the right internal jugular and 2 were placed in the subclavian [39]. No cases of pneumothorax or hemothorax were identified, and 15.3% of CVCs were improperly positioned. Only one (0.5%) of these was deemed clinically significant and repositioned after the chest radiograph was performed. They concluded that routine chest radiographs consume valuable time and resources and rarely affect management. Selection should be guided by clinical factors [39]. Swan-Ganz Catheter Previously mentioned studies incorporated the position and potential complications of Swan-Ganz catheter placements shown on chest radiographs obtained immediately postprocedure. The majority of complications, which occur in approximately 10% of catheter insertions, are minor and require catheter repositioning [24,26,29,40]. The pneumothorax rate was approximately 2% [26,40]. Central Venous Catheter In a prospective, blinded, observational study of 210 consecutive patients undergoing emergency central venous catheterization, US was compared with chest radiography to verify the correct CVC placement and to identify mechanical complications; there was a high correlation between these two modalities in identifying possible malpositioning of the catheter. However, the less time required to perform US allows earlier use of the catheter for the administration of acute therapies that can be lifesaving for critically ill patients [45]. Several studies demonstrated that LUS can reduce CVC insertion-to-use time and improve patient safety [46-48].