International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 4, Issue 7 | Review Article | Open Access DOI
Srishty Vij*
Srishty Vij, Rijul Bhatia, Kishalay Datta
Department of Emergency Medicine Max Hospital, Shalimar Bagh, New Delhi, India
*Correspondence to: Srishty Vij
Fulltext PDFCentral venous catheter (CVC) placement is a routine yet critical procedure in emergency and intensive care settings. Traditionally, a chest X-ray (CXR) has been mandated post-procedure to confirm catheter tip placement and detect complications such as pneumothorax or malposition. However, with the increasing use of real-time ultrasound guidance for CVC insertion, the relevance of routine post-insertion CXR is being re-evaluated. This review examines the necessity of routine CXR following ultrasound-guided CVC insertion, based on a prospective observational study conducted in a tertiary care hospital. A total of 100 adult patients underwent internal jugular vein catheterization under direct ultrasound guidance. Post-insertion confirmation was performed using point-of-care ultrasound (POCUS), including the assessment of bilateral lung sliding to rule out pneumothorax and the saline flush bubble test to verify catheter tip location in the right atrium. Chest X-rays were selectively performed in 28 patients, either due to protocol or clinician preference. No additional findings were revealed on CXR that were missed by ultrasound, and no patient required any intervention based on CXR results. Ultrasound demonstrated perfect concordance with chest radiography (Cohen’s κ = 1.0) in detecting post-procedural complications. These findings support the growing consensus that routine chest radiography may be unnecessary when comprehensive ultrasound-based confirmation is performed accurately and by trained personnel. Avoiding routine CXR in such scenarios may reduce time delays, radiation exposure, and healthcare costs without compromising patient safety. This aligns with current best practices and Choosing Wisely recommendations advocating for high-value, evidence-based care.
Internal Jugular vein, Central Venous catheter, POCUS, Chest X-ray, Saline “bubble” test
Srishty Vij, Rijul Bhatia, Kishalay Datta. Ultrasound at the Bedside- Redefining Post-CVC Imaging Standards. Int Clinc Med Case Rep Jour. 2025;4(7):1-10.