VALUE OF POSTPROCEDURAL CHEST RADIOGRAPHS IN THE ADULT INTENSIVE-CARE UNIT

Objective: To evaluate the necessity for post-procedural chest radiographs after catheterization of central veins, insertion of pulmonary artery catheters, and placement of endotracheal tubes. Design: Prospective, controlled study. Setting. Two academic tertiary adult ICUs. Patients: Consecutive patients (n = 316) requiring central vein cannulation or endotracheal intubation in the ICUs. Intervention: After each invasive procedure, the physician was instructed to complete a detailed evaluation sheet. Criteria based on the details of the procedure and immediate postprocedural clinical evaluation of the patient were used to determine the likelihood of a radiologically detectable complication. Actual radiologic findings were subsequently compared against clinical predictions. Main Outcome Measurements: Ability of housestaff to correctly predict the absence of radiologically detectable postprocedural complications (predictive negatives). Results: Ability to predict the absence of complications after cordis catheter insertions via the subclavian vein or internal jugular vein was very high (151/152; p < .001). Unsuspected complications were more frequent with central vein multilumen catheter insertions (3/24; p < .001). Ability to predict uncomplicated pulmonary artery catheterization was also high (110/111; p < .001). Physicians were unable to predict the majority of complications associated with endotracheal intubations (28/32; p > .50). Conclusions: The use of a protocol that includes an evaluation of the characteristics of the procedure and postprocedural physical examination can greatly reduce the need for routine chest radiographs after subclavian and internal jugular vein cordis catheterizations and pulmonary artery catheter placement. Chest radiographs should be performed after endotracheal intubation and multilumen catheter insertion.