Ultrasound-guided central line insertion in children: how much radiation
is really needed?
Background: A recent survey revealed that most pediatric surgeons use
intraoperative fluoroscopy and routine postoperative chest radiography
for catheter tip location in central line insertion. The aim of this
study is to review all cases of ultrasound-guided central line insertion
at a tertiary pediatric center and to evaluate the role of
intraoperative fluoroscopy and postoperative chest radiography.
Procedure: Retrospective data analysis of children submitted to
percutaneous central line insertion under ultrasound control over a
2-year period. Data collected included: age, indication for central
venous access, catheter type, usage of intraoperative fluoroscopy and
postoperative chest radiography usage, complications, and whether chest
radiography dictated any catheter-related intervention. Results:
Fifty-five long-term central lines were successfully established. All
patients had the catheter tip position confirmed either by
intraoperative fluoroscopy (96%), chest radiography (85%) or both
(82%). Catheter tip overlying the cardiac silhouette (right atrium) on
chest radiography was reported in 4 cases; these findings led to no
change in catheter positioning or other catheter-related intervention.
There were no catheter-related complications. Conclusions: Percutaneous
central line insertion under US-control was safe and effective.
Postoperative chest radiography did not dictate any modification of
catheter tip positioning after central line placement with ultrasound
and fluoroscopic control, thus should not be used routinely.