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Is Chest Radiography Necessary After Uncomplicated Insertion of a Triple-Lumen Catheter in the Right Internal Jugular Vein, Using the Anterior Approach?^*

^* From the Section of Pulmonary Medicine, Lenox Hill Hospital, New York, NY.

Correspondence to: Klaus-Dieter Lessnau, MD, FCCP, 300 East Ninety-Third St #18B, New York, NY 10128; e-mail: KLessnau{at}pol.net

Study objectives: Chest radiographs are required in many institutions by protocol after the insertion of a right internal jugular vein triple-lumen catheter (TLC), even if the anterior approach is used. This study investigates whether correct placement can be predicted during insertion and whether a "routine" postprocedural chest radiograph can be safely omitted.

Design: The operators included 18 first-, second-, or third-year medical residents, 3 pulmonary fellows, and a board-certified pulmonary medicine and critical care attending, with at least 1 certified physician present during the procedure. All operators were trained in the "seven number rule."

Patients: One hundred consecutive patients who required central venous access. Patients with left internal jugular vein or subclavian catheters were excluded.

Setting: Single institution, medical ICU, step-down unit, and floors.

Interventions: Right internal jugular vein TLC insertion, anterior approach, with subsequent chest radiograph.

Measurements and results: Eighty-eight patients had uncomplicated insertions, as defined by fewer than four sticks with a 22-gauge pathfinder needle and fewer than four slides with the 18-gauge introducer needle. Ninety-eight catheters were in accurate position, 1 catheter was in the distal superior cava vein, and 1 catheter was in an S-shaped position.

Conclusions: It is safe to omit the routine chest radiograph after uncomplicated insertion of a TLC. IV treatment can be initiated early. However, if there is any doubt about the correct position, a chest radiograph should be obtained.

Key Words: catheterization • central venous • chest • intraoperative complications • jugular veins • medicine • postoperative complications • radiography

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