Central Line/Vascular Access Placement

Preliminary Diagnosis: Central line vascular access placement

I. What imaging technique is first-line for this diagnosis?

AP and lateral chest radiograph.

II. Describe the advantages and disadvantages of this technique for assessing the proper placement of central lines.

Advantages

• Can demonstrate relatively accurately the position of the central line.

• Inexpensive.

• Can be performed quickly.

• Can be obtained at the bedside.

• Can screen for malpositioning as well as pneumothorax or hemothorax.

Disadvantages

• Minimal ionizing radiation exposure.

• May have difficulty distinguishing between catheter tip placement in the ascending aorta versus that in the superior vena cava.

III. What are the contraindications for the first-line imaging technique?

Some institutions may require consent be obtained if the patient is pregnant, in which case appropriate shielding should be performed.

IV. What alternative imaging techniques are available?

Fluoroscopy with IV contrast injected through the central line.

V. Describe the advantages and disadvantages of the alternative techniques for assessing the proper placement of central lines.

Fluoroscopy with IV contrast injected through central line

Advantages

• Definitively diagnostic.

• Can determine if the central line is intact and patent.

• Can detect the presence of a fibrin sheath or thrombus.

Disadvantages

• Requires the use of iodinated contrast.

• Requires a fluoroscopy suite and radiologist to perform.

• Despite being performed quickly, may use relatively high dose of radiation.

VI. What are the contraindications for the alternative imaging techniques?

Fluoroscopy with IV contrast injected through central line

• Pregnancy.

• Creatinine >1.6.

• Contrast allergy.