Abstract
Background: Subclavian vein central venous catheterization and the subsequent exchange
of subclavian catheters over a guidewire are frequently performed procedures. We hypothesized
that the policy of obtaining a routine postprocedure chest radiograph to confirm appropriate
catheter placement and to rule out complications after exchanging central venous catheters
over a wire was no longer justifiable.
Methods: A retrospective study of 295 patients with Swan-Ganz catheters (SGC) was
performed between July 1, 1994 and June 30, 1996. One hundred fourteen of these SGCs
were exchanged over a guidewire for a central venous catheter (CVC). Postexchange
chest radiograph and associated radiologist’s report, as well as age, gender, and
duration of catheter placement were all recorded. Since July 1996, this study has
been extended prospectively.
Results: Of the 380 documented over-a-wire exchanges, none has resulted in a complication,
including catheter malposition.
Conclusion: We conclude from these data that a routine chest radiograph following
the replacement of a CVC over a guidewire is not necessary when good clinical judgment
and discrimination are used in a monitored setting.
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© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
