Evaluation of Central Venous Catheter Insertion using Chest X‑ray in Critically Ill Patients

Background: Central venous catheterization is a routine procedure in the intensive care unit (ICU) often requiring the assistance of radiological techniques. The National Institute for Health and Clinical Excellence guidelines strongly advise that the radiological marker for CVC tip be located in the superior vena cava and outside the pericardial sac, which corresponds to the level of the carina based on studies of embalmed cadavers. Objectives: The aim was to determine the justification for the post‑CVC insertion chest radiograph and to determine if the chest radiograph can accurately confirm correct CVC tip placement. Materials and Methods: Fifty consecutive patients on admission in the ICU between January and December 2013, who required central venous catheterization, were studied. Catheterization was performed under strict asepsis via the right internal jugular vein by a skilled Anesthetist. Postcatheterization chest radiographs (anterior-posterior views) were performed. Results: The mean age was 36.59 ± 14.69 years, male patients constitute 30 (60%), and females were 20 (40%). CVC tips were correctly inserted in 36 patients (72%) and misplaced in 14 (28%) patients. Conclusion: The use of postinsertion chest radiograph was accurate in the determination of correct catheter tip placement. The high prevalence of misplaced catheter noted justifies the need for the chest radiograph after CVC insertion.