Designing a scoring system for selecting cases requiring chest radiography after central venous catheterization

Central venous catheterization (CVC) is a common procedure associated with various side effects such as pneumothorax. Recently، the routine post-catheterization chest X-ray has been challenged. The aim of the present study was to design a scoring system for selecting patients requiring radiography after CVC procedure. In this cross-sectional study، 210 patients requiring CVC were enrolled in the study and pneumothorax potential risk factors، including body mass index>30، history of neck or chest surgery، emphysematous disease، history of catheterization، number of punctures، inappropriate position during CVC، and treatment with ventilator were recorded. Finally، chest radiography and clinical signs before and after CVC were compared and scoring system sensitivity and specificity were determined. Incidence of pneumothorax was 5. 24%. The number of punctures and patient''s position and history of catheterization showed significant associations with pneumothorax development (p<0. 001). Pneumothorax incidence in patients with score> 4 was 80% which was significantly higher than patients with score<4 (OR: 174. 2، p<0. 001). Sensitivity and specificity of using the scoring system at cut-off score> 2 were 81. 8% and 87. 9%، respectively. The results of this study showed that pneumothorax development risk is very low in patients with score<2 and there is no need for post CVC routine chest X-ray. However، in patients with score>4، pneumothorax development risk is high and it seems that chest radiography with close intervals even more than one time is necessary. Further studies are recommended to validate the proposed scoring system.