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Pediatric Radiology
Published in: Pediatric Radiology 7/2021

01-06-2021 | Ultrasound | Original Article

Confirmatory radiographs have limited utility following ultrasound-guided tunneled femoral central venous catheter placements by interventional radiology

Authors: Spencer B. Lewis, Jeffrey Forris Beecham Chick, Kevin S. H. Koo, Andrew J. Woerner, Joseph Reis III, Giridhar M. Shivaram, David S. Shin, Eric J. Monroe

Published in: Pediatric Radiology | Issue 7/2021

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Abstract

Background

Ultrasonography may reliably visualize both appropriately positioned and malpositioned femoral-approach catheter tips. Radiography may be used to confirm catheter tip position after placement, but its utility following intraprocedural ultrasound (US) catheter tip verification is unclear.

Objectives

To report the utility of confirmatory radiographs after US-guided tunneled femoral central venous catheter (CVC) placements by interventional radiology in pediatric patients.

Materials and methods

A total of 484 pediatric patients underwent bedside US-guided tunneled femoral CVC placements in an intensive care setting at a single tertiary children’s hospital between Jan. 1, 2016, and April 20, 2020. Technical success, adverse events, post-procedure radiographic practices and inter-modality catheter tip concordance were recorded. All radiographs were performed within 12 h of catheter placement.

Results

The mean patient age was 175±508 days (range: 1 day to 19 years), including 257 (53.1%) males and 227 (46.9%) females. Of the 484 attempted placements, 472 (97.5%) were primary placements. Four hundred eighty-one (99.4%) placements were technically successful. There were three (0.6%) technical failures due to previously undiagnosed iliofemoral venous occlusive disease. Five (1.0%) adverse events occurred. Radiographs were obtained within 12 h of CVC placement in 171 (35.3%) patients, in 120 (70.2%) of whom the indication was recent catheter placement. All 171 (100%) post-placement radiographs showed catheter tip location concordance with the intra-procedural US. In one (0.2%) patient, in whom there was nonvisualization of a guidewire and clinical concern for malposition during US-guided placement, post-procedure radiographs, coupled with multiplanar venography, demonstrated inadvertent paravertebral venous plexus catheter placement.

Conclusion

The concordance between intra-procedural US and confirmatory post-procedure radiographs of CVC placements by interventional radiology obviates the need for routine radiographs. Radiographs may be obtained in instances of proceduralist uncertainty or clinical concern.
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Metadata
Title
Confirmatory radiographs have limited utility following ultrasound-guided tunneled femoral central venous catheter placements by interventional radiology
Authors
Spencer B. Lewis
Jeffrey Forris Beecham Chick
Kevin S. H. Koo
Andrew J. Woerner
Joseph Reis III
Giridhar M. Shivaram
David S. Shin
Eric J. Monroe
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 7/2021
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-020-04957-x

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