Authors: Hourmozdi JJ et al., Crit Care Med 2016 Mar 31;
Very few complications were picked up by routine chest x-ray at a large academic hospital system.
For decades, dogma has been that chest x-ray should be performed to confirm placement of all internal jugular (IJ) central lines, despite evidence that ultrasound can significantly reduce complication rates. These authors retrospectively assessed detection of complications by routine chest x-rays obtained after ultrasound-guided placement of right IJ central lines in adults at an academic tertiary hospital system.
During 2014, a total of 1322 right IJ central lines were placed with ultrasound guidance in emergency departments, intensive care units, and general wards. Overall, 97% of attempts were successful. Chest x-ray detected 1 (0.1%) pneumothorax, 13 (1.0%) misplaced catheters that required repositioning, and no arterial placements.
For ultrasound-guided, right IJ lines, these findings suggest that routine chest x-ray may eventually be replaced by ultrasound to assess for placement complications. The findings also demonstrate that resuscitation should not be delayed by waiting for the confirmatory x-ray. The case is closed when it comes to the requirement for using ultrasound for IJ line placement. If you aren’t using it, be prepared for the difficult conversation explaining why.