Is routine postoperative chest x-ray necessary after fluoroscopic-guided subclavian central venous port placement?

Abstract

Two uncommon but serious complications after subclavian central venous port (SCVP) placement are pneumothorax (PNX) and malposition of the catheter. Chest x-rays (CXR) are commonly obtained after SCVP placement to identify these complications, but their use is controversial. We performed a retrospective review of SCVP placements to establish the incidence of PNX or catheter malposition identified exclusively by postprocedure CXR. Between July 1, 2001, and June 30, 2006, 205 patients underwent elective SCVP placement. Although 4 patients (2%) sustained a PNX, none was identified by routine postprocedure CXR. Postprocedure clinical symptoms (3 to 72 hours later) prompted repeat CXR, which identified the PNX. Five patients (2.4%) had catheter malposition recognized by intraoperative fluoroscopy and corrected intraoperatively. No malpositioned catheters were identified on postprocedure CXR. In our study, incidence of PNX after SCVP placement was low, and PNX was not detected by intraoperative fluoroscopy or by routine postprocedure CXR. We conclude that the practice of routine postprocedure CXR after SCVP placement is not necessary and should be replaced with diagnostic chest radiography only if symptoms develop.