Introduction: The objective was to determine the need for daily chest radiographs (CXR) for assessment of catheter migration in patients with pulmonary artery catheter (PAC). Methods: 100 consecutive patients with PAC in the trauma and surgical ICUs of an academic medical center were prospectively evaluated. Clinical criteria for optimal PAC placement were evaluated at the time of CXR and were compared with CXR findings of PAC location as interpreted by an attending radiologist or intensivist. Clinical criteria was defined as: 1. air required to obtain wedge tracing ≥ 1.25 cc (normal), < 1.25 cc (abnormal), and 2. centimeter marking of PAC at introducer hub ≤ 1 cm migration (normal), > 1 cm (abnormal). Results: 390 comparisons of clincal criteria for PAC location and CXR findings were performed. The CXR revealed that the PAC required repositioning in 15 instances (4%). In 11/15 (73%) of these cases in which the clinical criteria for adequate PAC placement was not met, but CXR findings demonstrated adequate placement. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of abnormal clinical criteria were: sensitivity 73%, specificity 82%, accuracy 81%, PPV 14%, and NPV 99%. Conclusions: Less than 4% of PAC required manipulation as determined by CXR. PAC malposition can be reliably excluded (NPV 99%) through observation of specific clinical criteria. Clinical criteria may permit an 80% reduction in the need for daily CXR to validate PAC location. Routine daily CXR to assess PAC placement does not appear to be justified when specific clinical criteria are utilized. Clinical criteria vs. CXR CXR normal CXR abnormal Total Clinical normal 306 4 310 Clinical abnormal 69 11 80 Total 375 15 390.
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine