Ultrasound-guided central line insertion in children: how much radiation is really needed?

Background: A recent survey revealed that most pediatric surgeons use intraoperative fluoroscopy and routine postoperative chest radiography for catheter tip location in central line insertion. The aim of this study is to review all cases of ultrasound-guided central line insertion at a tertiary pediatric center and to evaluate the role of intraoperative fluoroscopy and postoperative chest radiography. Procedure: Retrospective data analysis of children submitted to percutaneous central line insertion under ultrasound control over a 2-year period. Data collected included: age, indication for central venous access, catheter type, usage of intraoperative fluoroscopy and postoperative chest radiography usage, complications, and whether chest radiography dictated any catheter-related intervention. Results: Fifty-five long-term central lines were successfully established. All patients had the catheter tip position confirmed either by intraoperative fluoroscopy (96%), chest radiography (85%) or both (82%). Catheter tip overlying the cardiac silhouette (right atrium) on chest radiography was reported in 4 cases; these findings led to no change in catheter positioning or other catheter-related intervention. There were no catheter-related complications. Conclusions: Percutaneous central line insertion under US-control was safe and effective. Postoperative chest radiography did not dictate any modification of catheter tip positioning after central line placement with ultrasound and fluoroscopic control, thus should not be used routinely.