Confirmatory radiographs have limited utility following ultrasound-guided tunneled femoral central venous catheter placements by interventional radiology



Ultrasonography may reliably visualize both appropriately positioned and malpositioned femoral-approach catheter tips. Radiography may be used to confirm catheter tip position after placement, but its utility following intraprocedural ultrasound (US) catheter tip verification is unclear.


To report the utility of confirmatory radiographs after US-guided tunneled femoral central venous catheter (CVC) placements by interventional radiology in pediatric patients.

Materials and methods

A total of 484 pediatric patients underwent bedside US-guided tunneled femoral CVC placements in an intensive care setting at a single tertiary children’s hospital between Jan. 1, 2016, and April 20, 2020. Technical success, adverse events, post-procedure radiographic practices and inter-modality catheter tip concordance were recorded. All radiographs were performed within 12 h of catheter placement.


The mean patient age was 175±508 days (range: 1 day to 19 years), including 257 (53.1%) males and 227 (46.9%) females. Of the 484 attempted placements, 472 (97.5%) were primary placements. Four hundred eighty-one (99.4%) placements were technically successful. There were three (0.6%) technical failures due to previously undiagnosed iliofemoral venous occlusive disease. Five (1.0%) adverse events occurred. Radiographs were obtained within 12 h of CVC placement in 171 (35.3%) patients, in 120 (70.2%) of whom the indication was recent catheter placement. All 171 (100%) post-placement radiographs showed catheter tip location concordance with the intra-procedural US. In one (0.2%) patient, in whom there was nonvisualization of a guidewire and clinical concern for malposition during US-guided placement, post-procedure radiographs, coupled with multiplanar venography, demonstrated inadvertent paravertebral venous plexus catheter placement.


The concordance between intra-procedural US and confirmatory post-procedure radiographs of CVC placements by interventional radiology obviates the need for routine radiographs. Radiographs may be obtained in instances of proceduralist uncertainty or clinical concern.

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  1. 1.

    Sharma D, Farahbakhsh N, Tabatabaii SA (2019) Role of ultrasound for central catheter tip localization in neonates: a review of the current evidence. J Matern Fetal Neonatal Med 32:2429–2437

  2. 2.

    Katheria AC, Fleming SE, Kim JH (2013) A randomized controlled trial of ultrasound-guided peripherally inserted central catheters compared with standard radiograph in neonates. J Perinatol 33:791–794

    CAS  Article  Google Scholar 

  3. 3.

    Chau A, Hernandez JA, Pimpalwar S et al (2018) Equivalent success and complication rates of tunneled common femoral venous catheter placed in the interventional suite vs. at patient bedside. Pediatr Radiol 48:889–894

    Article  Google Scholar 

  4. 4.

    Nguyen J (2016) Ultrasonography for central catheter placement in the neonatal intensive care unit—a review of utility and practicality. Am J Perinatol 33:525–530

    Article  Google Scholar 

  5. 5.

    Chick JFB, Reddy SN, Yam BL et al (2017) Institution of a hospital-based central venous access policy for peripheral vein preservation in patients with chronic kidney disease: a 12-year experience. J Vasc Interv Radiol 28:392–397

    Article  Google Scholar 

  6. 6.

    Gaballah M, Krishnamurthy G, Keller MS et al (2014) US-guided placement and tip position confirmation for lower-extremity central venous access in neonates and infants with comparison versus conventional insertion. J Vasc Interv Radiol 25:548–555

  7. 7.

    Jain A, McNamara PJ, Ng E, El-Khuffash A (2012) The use of targeted neonatal echocardiography to confirm placement of peripherally inserted central catheters in neonates. Am J Perinatol 29:101–106

    Article  Google Scholar 

  8. 8.

    Subramanian S, Moe DC, Vo JN (2013) Ultrasound-guided tunneled lower extremity peripherally inserted central catheter placement in infants. J Vasc Interv Radiol 24:1910–1913

    Article  Google Scholar 

  9. 9.

    von Elm E, Altman DG, Egge M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–578

    Article  Google Scholar 

  10. 10.

    Woerner A, Wenger JL, Monroe EJ (2020) Single-access ultrasound-guided tunneled femoral lines in critically ill pediatric patients. J Vasc Access 21:1034–1041

    Article  Google Scholar 

  11. 11.

    Khalilzadeh O, Baerlocher MO, Shyn PB et al (2017) Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 28:1432–1437 e3

    Article  Google Scholar 

  12. 12.

    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202

  13. 13.

    Ramamurthi A, Chick JFB, Srinivasa RN et al (2018) Chest radiograph measurement technique facilitates accurate bedside peripherally inserted central catheter placement in children. Cardiovasc Intervent Radiol 41:443–448

    Article  Google Scholar 

  14. 14.

    Woodland DC, Cooper CR, Rashid MF et al (2018) Routine chest X-ray is unnecessary after ultrasound-guided central venous line placement in the operating room. J Crit Care 46:13–16

    Article  Google Scholar 

  15. 15.

    Lau CSM, Chamberlain RS (2016) Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res 80:178–184

    Article  Google Scholar 

  16. 16.

    Snyder EJ, Zhang W, Jasmin KC et al (2018) Gauging potential risk for patients in pediatric radiology by review of over 2,000 incident reports. Pediatr Radiol 48:1867–1874

    Article  Google Scholar 

  17. 17.

    Keller EJ, Aragona E, Molina H et al (2019) Cost-effectiveness of a guided peripherally inserted central catheter placement system: a single-center cohort study. J Vasc Interv Radiol 30:709–714

    Article  Google Scholar 

  18. 18.

    Tan J, Liu L, Xie J et al (2016) Cost-effectiveness analysis of ultrasound-guided Seldinger peripherally inserted central catheters (PICC). Springerplus 5:2051

    Article  Google Scholar 

  19. 19.

    Hayatghaibi SE, Chau A, Wadler EG et al (2020) Cost comparison of in-suite versus portable tunneled femoral central line placements in children using time-driven activity-based costing. J Am Coll Radiol 17:462–468

    Article  Google Scholar 

  20. 20.

    Nguyen B-V, Prat G, Vincent J-L et al (2014) Determination of the learning curve for ultrasound-guided jugular central venous catheter placement. Intensive Care Med 40:66–73

    Article  Google Scholar 

  21. 21.

    Omid M, Rafiei MH, Hosseinpour M et al (2015) Ultrasound-guided percutaneous central venous catheterization in infants: learning curve and related complications. Adv Biomed Res 4:199

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    McGrath E, Ranstrom L, Lajoie D et al (2017) Is a chest radiograph required after removal of chest tubes in children? J Pediatr Health Care 31:588–593

    Article  Google Scholar 

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Correspondence to Eric J. Monroe.

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Jeffrey Forris Beecham Chick is a consultant and speaker for Guerbet and C. R. Bard. Eric J. Monroe is a scientific adviser and speaker for Biogen.

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Lewis, S.B., Chick, J.F.B., Koo, K.S.H. et al. Confirmatory radiographs have limited utility following ultrasound-guided tunneled femoral central venous catheter placements by interventional radiology. Pediatr Radiol (2021).

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  • Central venous catheter
  • Children
  • Femoral
  • Neonates
  • Radiography
  • Ultrasound-guided