Routine chest radiographs following central venous recatheterization over a wire are not justified

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.