Relationship between chest port catheter tip position and port malfunction after interventional radiologic placement

PURPOSE: The relationship between catheter tip position of implanted subcutaneous chest ports and subsequent port malfunction was investigated. Tip movement from initial supine position to subsequent erect position was also evaluated. MATERIALS AND METHODS: Patients who underwent imaging-guided internal jugular chest port placement between July 2001 and May 2003 were identified with use of a quality-assurance database. Sixty-two patients were included in the study (22 men and 40 women), with a mean age of 58 years (range, 27-81 years). Catheter tip location on the intraprocedural chest radiograph was determined with use of two methods. First, the distance from the right tracheobronchial angle (TBA) was recorded (TBA distance). Second, tip location was classified into six anatomic regions: 1, internal jugular veins; 2, brachiocephalic veins; 3, superior vena cava (SVC; n = 11); 4, SVC/right atrial junction (n = 22); 5, upper half of right atrium (n = 25); and 6, lower half of right atrium (n = 4). For the duration of follow-up, catheter tip location was documented, as were all episodes of catheter malfunction. RESULTS: Patients with catheter tips initially placed in position 3 had a higher risk of port malfunction (four of 11; 36%) than patients with catheter tips located in position 5 (two of 25; 8%). This difference narrowly fell short of statistical significance (P =.057). When comparing intraprocedural chest radiographs to the first erect chest radiographs, significant upward tip movement was noted. The tips migrated cephalad an average of 20 mm (P =.003) and 1.0 position units (P =.001). DISCUSSION: Catheter tips placed in the SVC tended to have a greater risk of port malfunction compared with those positioned in the right atrium. Chest ports migrated cephalad between the supine and erect positions.     

Routine chest radiographs after central line insertion: Mandatory postprocedural evaluation or unnecessary waste of resources?

Purpose: To study the cost and impact on patient management of the routine performance of chest radiographs in patients undergoing imaged-guided central venous catheter insertion. Methods: Six hundred and twenty-one catheters placed in 489 patients over a 42-month period formed the study group. Catheters were placed in the right internal jugular vein (425), left internal jugular vein (133), and subclavian veins (63). At the end of the procedure fluoroscopy was used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients. Results: Postprocedural chest fluoroscopy showed no evidence of pneumothorax, hemothorax, or mediastinal hematoma. Inappropriate catheter tip position or catheter kinks were noted with 90 catheters. These problems were all corrected while the patient was on the interventional table. Postprocedural chest radiographs showed no complications but proximal catheter tip migration was noted in six of 621 catheters (1%). These latter six catheters required further manipulation. The total technical and related charges for the postprocedural chest radiographs in this series were estimated at ￡15,525. Conclusion: Postprocedural chest radiographs after image-guided central venous catheter insertion are not routinely required. A postprocedural chest radiograph can be performed on a case-by-case basis at the discretion of the interventional radiologist.     

Impending catheter perforation of superior vena cava: radiographic recognition

In six of nine patients with superior vena caval perforation by a central venous catheter, the chest radiograph showed a gentle curve at the tip of the catheter 4 hr to 7 days before clinical or radiographic recognition of perforation. This radiographic sign should prompt catheter repositioning to avoid the morbidity and potential mortality associated with superior vena caval perforation.     

Cavoatrial junction and central venous anatomy: implications for central venous access tip position

PURPOSE: To quantify the anatomic relationships of the cavoatrial junction and propose a system for describing central venous access device tip location on the basis of structures visible on chest radiographs. MATERIALS AND METHODS: The authors performed a retrospective study of 100 consecutive computed tomographic (CT) studies from a predominantly pediatric population consisting of 52 male and 48 female patients aged 12-28 years (mean age, 16 years). With use of multiplanar and scout images, relevant mediastinal structures were marked, vertebral levels were noted, and measurements were made electronically. Catheter tip positions were recorded in the 26 children who had central catheters. RESULTS: A vertebral body unit was defined as the distance between the inferior endplate of one vertebra to the inferior endplate of the next, with the upper intervertebral disk included. The most reliable estimate of cavoatrial junction position is a point two vertebral body units below the carina; there was no association with patient age or other parameters. CONCLUSIONS: A more accurate understanding of the superior vena cava anatomy is essential for the correct interpretation of central venous access device position. The true cavoatrial junction is located more inferiorly than commonly believed and is not accurately estimated with commonly used imaging landmarks. A point two vertebral body units below the carina enables the reliable estimate of the position of the cavoatrial junction. Catheter tip position can be most reliably described in vertebral body units below the carina, with use of the thoracic spine as an internal ruler.     

Efficacy and safety of hepatic artery infusion catheter placement without fixation in the right gastroepiploic artery

PURPOSE: To evaluate the feasibility of placing the tip of an infusion catheter in the right gastroepiploic artery via the femoral route and whether coil placement in the gastroduodenal artery and around the infusion catheter tip should be performed to avoid gastroduodenal toxicity and catheter dislocation. MATERIALS AND METHODS: Seventy-eight patients (25 women and 53 men; age, 38-79 years; mean, 63 years) underwent implantation of a 5-F chemotherapeutic infusion catheter via the femoral artery, positioned so that the tip was in the right gastroepiploic artery and a side hole was in the common hepatic artery. Patients were randomly divided into two groups: group A included patients with coil placement in the gastroduodenal artery and around the infusion catheter tip and group B included patients without coil placement. RESULTS: Catheter placement via the femoral route was successful in 70 of 78 patients (90%). Mean catheter indwell durations were 250 days (range, 0-962 days) in group A (n = 35) and 230 days (range, 0-834 days) in group B (n = 43; P = .9). Complications relating to long-term catheter duration in the right gastroepiploic artery did not occur in any patient. Two patients in each group had abdominal pain during infusion chemotherapy. Endoscopy revealed acute gastric mucosal lesions. Dislocation of the catheter tip during treatment occurred in one patient in each group. CONCLUSION: Catheter placement in the right gastroepiploic artery is safe and feasible except in patients with a long and caudally oriented celiac trunk. Coil embolization of the gastroduodenal artery and around the catheter tip is unnecessary.     

Extravasation from venous catheter: a serious complication potentially missed by lung imaging

Three patients were referred for lung ventilation and perfusion (V/Q) imaging with symptoms strongly suggestive of pulmonary embolus (PE). Chest roentgenograms and xenon ventilation studies on all three were normal, save for prominent mediastinal silhouettes and effusions. Technetium-99m macroaggregated albumin (Tc-99m MAA), when injected through the central venous catheter (CVP), revealed mediastinal localization, whereas antecubital injections showed normal pulmonary perfusion. Contrast fluoroscopy introduced through the venous catheter in the first patient defined the extravasation. For patients under strong suspicion of PE, with a venous catheter whose distal tip is seen about the level of the heart on chest radiograph, we recommend administering the perfusion agent slowly through the central catheter to exclude catheter-induced complications. When extravasation is detected, injection of Tc-99m MAA by peripheral vein should be used to exclude PE.     

Placement of peripherally inserted central catheters without fluoroscopy in children: initial catheter tip position

PURPOSE: To determine how often placement of peripherally inserted central catheters (PICCs) without imaging guidance results in an initially correct central venous catheter tip location. MATERIALS AND METHODS: This study was approved by the hospital's institutional review board, which waived the requirement for informed consent. In a children's hospital, 843 PICCs were placed in 698 patients (age range, 0 days to 26 years; mean, 6.9 years) during a 14-month study period. All PICCs were placed by a specialized team of PICC nurses and interventional radiology technologists in an angiography suite with the supervision of pediatric interventional radiologists. All catheters were threaded blindly to a previously estimated length by either a PICC nurse or a pediatric interventional radiologist, according to National Association of Vascular Access Networks guidelines, and the initial PICC tip location was then determined by means of spot fluoroscopy. PICC tips were regarded as central if they resided anywhere within the superior vena cava (SVC). All catheters were then manipulated with intermittent fluoroscopic guidance to achieve a final central position in the distal third of the SVC. A chi2 test was used to compare initial and final PICC tip locations according to patient age, catheter size, accessed vein, and need for radiologist assistance. A t test was used to compare procedure time with and without radiologist assistance. RESULTS: Analysis included 843 consecutively placed pediatric PICCs, of which 723 (85.8%) had a noncentral initial PICC tip position and required additional manipulation. After catheter repositioning performed with intermittent fluoroscopic guidance, a final central PICC tip location was achieved in 760 PICCs (90.2%). CONCLUSION: Pediatric PICC placement without fluoroscopic guidance required catheter manipulation of initial PICC tip position in 723 cases (85.8%). PICC placement with fluoroscopic guidance is highly successful, and the authors believe it is best performed in an angiography suite.     

Accuracy of chest radiographs in the emergency diagnosis of heart failure

The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used. Statistical analysis included receiver-operating characteristic (ROC) analysis and calculation of a logistic regression model including B-type natriuretic peptide (BNP) levels. The reader's overall impression showed the highest area under the ROC curve for the diagnosis of HF in both supine and erect patient positions (0.855 and 0.857). Among individual radiographic findings, peribronchial cuffing in the supine position (0.829) showed the highest accuracies. The lowest accuracy was found for the vascular pedicle width in the supine position (0.461). Logistic regression analysis showed no significant differences between the reader's overall impression, the radiographic model, and BNP testing. In our study, the combination of radiographic features provided valuable information and was of comparable accuracy as BNP-testing for the diagnosis of HF.     

Change in peripherally inserted central catheter tip position with abduction and adduction of the upper extremity

PURPOSE: This study examines whether the tip of peripherally inserted central catheters (PICCs) moves significantly with changes in arm position from abduction to adduction. MATERIALS AND METHODS: The catheters were inserted in the brachial or basilic veins under ultrasonographic guidance with the upper extremity in a 90 degrees abducted position. A flexible, radiopaque ruler was then placed on the anterior chest and digital images were obtained with the arm abducted and adducted in a similar phase of quiet respiration. Catheter tip movement was measured with use of the radiopaque ruler and fixed, bony anatomic landmarks. RESULTS: Sixty-one consecutive PICCs were placed and evaluated during the study period (eight patients were excluded). Thirty-three catheters were placed from the right arm and 20 from the left. Overall, 43 moved caudally, seven moved cephalad, and three did not move with movement of the arm from abduction to adduction. Of those that moved caudal, the mean distance of movement was 21 mm (range, 2-53 mm). Right arm PICCs tended to move more than left arm PICCs, but this did not attain significance (P = .29). CONCLUSIONS: There is a tendency for the PICC tip to move in a caudal direction with the change in arm position from abduction to adduction; 58% of PICCs moved 20 mm or more. This change in position should be considered during final catheter tip positioning.     

Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis

Central venous catheters (CVCs) are associated with occlusive, infectious, and thrombotic complications. The aim of this study was to determine if internal CVC tip position was correlated with subsequent complications. This was an institutional review board approved single-center retrospective review of 169 consecutive patients who underwent placement of 203 semipermanent CVCs. Using post-placement chest X-rays, a de novo scale of internal catheter tip position was developed. Major complications were recorded. A logistic regression analysis was used to determine if catheter tip position predicted subsequent complications. There were 78 men and 91 women with a mean age of 48?±?11 years. There were 21 catheter tips placed in the subclavian/innominate veins, 32 in the upper superior vena cava, 113 in the atriocaval junction, and 37 in the right atrium. There were 83 complications occurring in 61 (36.1 %) patients, including sepsis in 40 (23.7 %), venous thrombosis in 18 (10.7 %), catheter occlusion in 16 (9.5 %), internal catheter repositioning in 6 (3.6 %), pneumothorax in 2 (1.2 %), and death in 1 (0.6 %). An internal catheter tip position peripheral to the atriocaval junction resulted in a catheter that was more likely to undergo internal repositioning (p?<?0.001) and venous thrombosis (p?<?0.001). Patients with femoral catheters were more likely to develop sepsis (45 %) than patients whose catheters were inserted through the upper extremity veins (18 %) (p?<?0.01). In conclusion, to reduce catheter-associated morbidity and potentially mortality, the internal catheter tip should be positioned at the atriocaval junction or within the right atrium and femoral insertion sites should be avoided whenever possible.     

Intraobserver and interobserver agreement of the interpretation of pediatric chest radiographs

The objective of this study is to quantify the magnitude of intraobserver and interobserver agreement among physicians for the interpretation of pneumonia on pediatric chest radiographs. Chest radiographs that produced discordant interpretations between the emergency physician and the radiologist's final interpretation were identified for patients aged 1–4 years. From 24 radiographs, eight were randomly selected as study radiographs, and 16 were diversion films. Study participants included two pediatric radiologists, two senior emergency medicine physicians, and two junior fellowship-trained pediatric emergency medicine physicians. Each test included 12 radiographs: the eight study radiographs and four randomly interspersed diversion radiographs, and each radiograph was paired with a written clinical vignette. Testing was repeated on four occasions, separated by ≥2 weeks. The dependent variable was the interpretation of presence or absence of pneumonia; primary analysis done with Cohen's kappa (95% confidence intervals). Intraobserver agreement was good for pediatric radiologists (kappa = 0.87; 95% CI 0.60–0.99) for both but was lower for senior emergency physicians (mean kappa = 0.68; 95% CI 0.40–0.95) and junior pediatric emergency physicians (mean kappa = 0.62; 95% CI 0.35–0.98). Interobserver agreement was fair to moderate overall; between pediatric radiologists, kappa = 0.51 (0.39–0.64); between senior emergency physicians, kappa = 0.55 (0.41–69), and between junior pediatric emergency medicine physicians, kappa = 0.37 (0.25–0.51). Practicing emergency clinicians demonstrate considerable intraobserver and interobserver variability in the interpretation of pneumonia on pediatric chest radiographs.     

Congenital diaphragmatic hernia in neonates: variations in umbilical catheter and enteric tube position

PURPOSE: To evaluate anatomic variations of support apparatus position on radiographs obtained in neonates with congenital diaphragmatic hernia (CDH). MATERIALS AND METHODS: The authors evaluated radiographs obtained in 71 neonates with CDH to determine whether nasogastric tubes, umbilical venous catheters, and umbilical arterial catheters deviated from their expected anatomic course. The relationship between deviation patterns and hernia contents was evaluated. RESULTS: Sixty-eight neonates-54 with left-sided CDH and 14 with right-sided CDH-had a nasogastric tube. The tubes in 21 patients with left-sided CDH had a normal anatomic course at radiography. Nineteen of these patients did not have stomach in the hernia. In 13 patients, the tip of the nasogastric tube was lodged at the esophagogastric junction. In 17 patients, the tube was in the left hemithorax. In all 30 of these patients, the stomach was within the CDH. All nasogastric tubes in the 14 patients with right-sided CDH had leftward deviation. Thirty-seven patients-27 with left-sided CDH and 10 with right-sided CDH-had umbilical venous catheters. The catheters in 12 patients with left-sided CDH had apex leftward convexity. The umbilical venous catheter in eight patients with right-sided CDH had rightward shift; all eight patients had liver herniation. CONCLUSION: The positions of nasogastric tubes and umbilical venous catheters vary in several predictable patterns in neonates with CDH. Knowledge of these variations may be helpful for supporting the diagnosis of CDH in unclear cases and thus avoiding unnecessary apparatus adjustments, and for predicting hernia contents.     

Radiographically guided percutaneous catheter drainage of pleural fluid collections

We reviewed the outcome of guided percutaneous catheter drainage of pleural fluid collections in 18 patients over a 5-year period. Catheter positioning was guided by fluoroscopy in 10 (56%) cases, CT in seven (39%), and sonography in one (6%). Included were 16 patients with empyemas and one each with a sterile hematoma and transudate. In nine of the patients, previous surgical chest tube drainage had been unsuccessful. The majority of collections were treated with a 12- or 14-French catheter and closed underwater seal drainage. Twelve (80%) of the 15 patients who had an adequate trial of guided drainage were cured. Propyliodone oil suspension contrast sinography after catheter placement showed two clinically unsuspected bronchopleural fistulas. Although an extensive multilocular pleural collection was a contraindication to percutaneous catheter drainage, the thick fibrous peel of a chronic empyema was not. Drainage of pleural fluid collections with radiographic guidance ensures proper catheter placement and is successful in a high percentage of cases.     

Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy

PURPOSE: To investigate the technical outcome of radiologic catheter placement with use of a side-hole catheter with distal fixation for hepatic arterial infusion chemotherapy. MATERIALS AND METHODS: Between January 1993 and September 1999, 426 patients were referred to our department to undergo intraarterial infusion chemotherapy for unresectable malignant liver tumors. A subclavian artery was exposed under local anesthesia and a catheter was inserted. After inserting the tip of the side-hole catheter into the gastroduodenal artery, splenic artery, or peripheral branch of the hepatic artery, the catheter tip was fixed to the vessel with use of coils and a mixture of n-butyl cyanoacrylate (NBCA) and iodized oil. The proximal end of the catheter was connected to an implanted port, and the port system was embedded subcutaneously. RESULTS: Placement was successful in 425 of 426 patients (99.8%) in a mean time of 76 minutes. Catheter dislodgement was noted in 12 patients (2.8%). Cumulative patency rates of the hepatic artery calculated according to the Kaplan-Meier method for the entire group were 91.0%, 81.4%, and 58.1% at 6 months and 1 and 2 years, respectively. Complications related to catheter placement were observed in nine cases and included dysfunction of the implanted system (n = 3), significant bleeding around the implanted port (n = 2), improper infusion of NBCA and iodized oil (n = 2), and cerebral infarction (n = 2). CONCLUSION: Radiologic catheter placement via a subclavian artery with side-hole catheter placement with distal fixation for hepatic arterial infusion chemotherapy is a highly successful procedure with a reduced risk of catheter dislodgment and arterial occlusion.     

Optimizing the patient positioning for PICC line tip determination

Central venous catheters (CVCs) are used for both emergent and long-term vascular access for the infusion of numerous therapeutic agents such as chemotherapy, parenteral nutrition, antibiotics, and analgesics, as well as for temporary hemodialysis or hemoperfusion [1]. Current standard of care dictates that CVC insertion should be followed by an immediate chest radiograph to confirm appropriate position [2]. Radiographic confirmation of central venous line placement is important because it is not possible to determine CVC tip position clinically. Although many catheter tips can be localized on the standard frontal radiograph, there are occasions when a second radiograph is necessary to localize the position of the CVC tip accurately [3]. We hypothesized that a right posterior obligue chest radiograph would more consistently enable the catheter tip to be seen as it reduces the superimposition of mediastinal structures. One hundred chest radiographs taken in an anteroposterior (AP) projection and 100 chest radiographs taken in a right posterior oblique (RPO) projection after a peripherally inserted central catheter (PICC) line placement at UCI Medical Center from June 2000 to November 2002 were read by two radiologists. Forty-one percent of AP readings were discrepant and 4% had the annotation difficult to identify the position of the tip although the identification of tip position was similar. Fifty-five percent of AP readings were in agreement with no note of any difficulty. Eighteen percent of RPO readings were discrepant and 2% had the annotation difficult to identify the position of the tip although the identification of tip position was similar. Eighty percent of RPO readings were in agreement with no note of any difficulty.     

Radiology residents' on-call interpretation of chest radiographs for pneumonia

RATIONALE AND OBJECTIVES: This study is designed to assess the performance of radiology residents in interpreting emergency department chest radiographs for pneumonia and to characterize chest radiographic findings in patients for which interpretation was amended by an attending radiologist. MATERIALS AND METHODS: We retrospectively reviewed all amended reports for chest radiographs performed on emergency department patients July 2002-June 2003. Reports preliminarily interpreted by residents and amended by a board-certified staff radiologist for the presence or absence of pneumonia were identified. A panel of three experienced radiologists, blinded to reports, jointly reviewed each chest radiograph. If the panel diagnosed pneumonia, the chest radiograph was evaluated for the projection that best showed the pneumonia, its size and location, and the presence or absence of the following features: increased opacity, air bronchograms, loss of vascular markings, silhouette sign, and linear opacities. The resident's post-graduate year (PGY) training level was noted. RESULTS: One percent (134/12,600 reports) of chest radiographic reports were amended for the presence or absence of pneumonia. One hundred chest radiographs were available and comprised the series. There were 56 females and 44 males with a mean age of 45 years (range, 1-99 years). The staff radiologist diagnosed pneumonia in 79% (79/100 radiographs). The panel agreed with the staff in 77% (kappa = 0.76) and the resident in 23% (kappa = 0.43). The panel diagnosed pneumonia in 60% (60/100 radiographs) with the following chest radiographic findings: 100% (60/60), increased opacity; 37% (22/60), air bronchograms; 72% (43/60), loss of vascular markings; 40% (24/60), silhouette sign; and 20% (12/60), linear opacities. The pneumonia was right sided in 52% (31/60), left sided in 37% (22/60), and bilateral in 11% (7/60). Right-sided pneumonias were equally distributed among the three lobes, and left-sided pneumonias had a lower-lobe predominance of 77% (17/22). Seventy-five percent (45/60) of pneumonias were segmental or smaller, and 82% (49/60) of chest radiographs showing pneumonia had both posteroanterior and lateral projections. The pneumonia was conspicuous on only one projection in 43% (21/49); the posteroanterior view in 22% (11/49), and the lateral view in 20% (10/49). Eighty-one percent (81/100) of interpreting residents were PGY-3. CONCLUSION: Interpretation of chest radiographs for pneumonia by PGY-3 residents has a low error rate. Missed pneumonias often were segmental or smaller and conspicuous on only one projection.     

Efficacy of chest radiography in pediatric intensive care

We prospectively evaluated the efficacy and clinical usefulness of bedside chest radiography in a pediatric intensive-care unit. Seven hundred ninety-five radiographs were evaluated in 126 patients over a 10-week period. Eighty-one percent of all radiographs showed one or more cardiopulmonary abnormalities, and 25% of routine radiographs had findings that altered management of patients. Nineteen percent of radiographs, including 17% of routine radiographs, showed a malpositioned tube or catheter. Thirty-five percent of endotracheal tubes shown on postintubation radiographs and 41% of central venous catheters shown on post-catheter placement radiographs were malpositioned. Forty-five percent of radiographs with a previous reading showed a significant interval change. Radiographs in patients 1 year old or younger showed more cardiopulmonary abnormalities (p less than .04), tube or catheter malpositions (p less than .03), and significant interval changes (p less than .03), and they elicited more changes in clinical management (p less than .01) than did radiographs in patients over 1 year old. The frequency of management changes dictated by radiographs increased with increasing amounts of respiratory support (p less than .01). Our data indicate that bedside radiography in the pediatric intensive-care setting has a high efficacy and clinical utility.     

超声引导联合腔内心电图定位在中心静脉置管中的应用

目的：探讨超声引导联合腔内心电图定位技术在中心静脉置管中的应用价值。 方法：回顾性分析我院2016年1月至2018年6月行超声引导下颈内静脉穿刺并经腔内心电图定位的52例中心静脉置管患者的临床资料,观察首次穿刺成功率、一次性置管到位率及置管并发症情况。 结果：52例患者首次穿刺成功50例,首次穿刺成功率为96.2%,首次穿刺失败需2次穿刺并置管成功2例。所有患者穿刺过程未出现颈动脉误穿、血气胸、空气栓塞等并发症。52例患者经腔内心电图定位后行胸部X线检查,均证实导管头端位置理想,置管深度一次性到位率100%。2例患者在调整最佳置管深度过程中出现一过性心律失常,均得到及时纠正。 结论：超声引导下颈内静脉穿刺可明确血管有无变异,准确引导穿刺,减少并发症,提高置管成功率。同时,腔内心电图可实时提示置管深度,便于及时、准确指导导管头端位置调整。     

Internal jugular and upper extremity central venous access in interventional radiology: is a postprocedure chest radiograph necessary?

OBJECTIVE: The necessity of obtaining a postprocedure chest radiograph after central venous access using the upper extremity or internal jugular veins and interventional radiologic techniques was evaluated. SUBJECTS AND METHODS: A prospective study of 937 consecutive central venous access procedures in interventional radiology using the internal jugular veins or upper extremities was performed from June 1995 through September 1997. Established interventional radiologic techniques were used to place various ports (n = 34) and tunneled (n = 670) and nontunneled (n = 233) catheters. All catheters were positioned using fluoroscopy and readjusted if necessary before termination of the procedure. Afterward, a chest radiograph was obtained with the patient upright to evaluate catheter position and possible procedural complications. Procedural complications and manipulations or interventions that resulted from the radiographic findings were noted. In addition, nursing time for acquisition of the chest radiograph was recorded. RESULTS: We found seven procedural complications (four air emboli, two pneumothoraces, one innominate vein laceration) significant enough to alter the patient's treatment. These complications were apparent during the examination. Postprocedure chest radiography failed to reveal any unknown complications and revealed only one catheter sufficiently malpositioned to require manipulation. The amount of nursing time to acquire postprocedure chest radiographs ranged from 8 to 40 min (mean, 23 min) per patient. CONCLUSION: When imaging guidance and interventional radiologic techniques are used for upper extremity and internal jugular central venous access, performing postprocedure chest radiography yields little benefit.