Safe & Sustainable Lines

Balancing Safety and Sustainability: Reassessing Routine Chest Radiography After Ultrasound-Guided Central and PICC Line Placement - Safe & Sustainable Lines

Status

Active, not recruiting

Phases

Unknown

Study type

Observational

Source

NL-OMON

Registry ID

NL-OMON58301

Enrollment

7000

Registered

2026-01-09

Start date

2026-01-12

Completion date

Unknown

Last updated

2026-01-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Central venous line placement

Interventions

None listed

Eligibility

Inclusion criteria

Inclusion criteria: Adult patients undergoing central line or PICC-line placement  in the OR or PACU by the anesthesia team or under supervision of an anesthesiologist. A post-procedure chest radiograph obtained within 6 hours of line insertion (to standardize “post-line CXR”.Available documentation (insertion time, site, side, catheter type/size, and operator role/grade, other).Index episode only (defined as first qualifying line per patient within the study window).

Exclusion criteria

Exclusion criteria: Patients who objected against the use or re-use of their data for research purposes. Lines not placed by the anesthesia team.Wire exchanges of existing catheters without new venipuncture.Femoral catherter placementECMO / IABP / PAC all for which chest Xray is mandatoryEmergent insertions in the ERCatheter insertion without ultrasound guidance.

Design outcomes

Primary

Measure	Time frame
Actionable CXR finding; defined as proportion of post-procedure chest radiographs that reveal an abnormality requiring immediate clinical intervention including: Catheter malposition necessitating repositioning or exchange, orPneumothorax requiring chest tube insertion	—

Secondary

Measure	Time frame
Safety and diagnostic yieldIncidence of malposition and pneumothorax in the cohort, including how often these events were already suspected or identified clinically or by bedside ultrasound/IC-ECG before CXR.Tip accuracy by reference standard: concordance between IC-ECG/targeted US and CXR (discrepancy rate).Complications categorized as immediate, early (<24h), and late (<7 days): hematoma, hemothorax, pneumothorax, arterial puncture, air aspiration, unsuccessful placement, infection, venous thrombosis, line occlusion, and others.Repeat imaging rate: need for additional imaging (repeat CXR or chest CT) related to line placement.Workflow and efficiencyTime to “line ready for use”: defined as the interval from documented start of the procedure in the EHR (HiX) to administration of the first dose of medication via the line (in hours).Delay attributable to CXR: insertion completion ? CXR order ? CXR acquisition ? report release ? line usability.Patient and procedure factorsPatient factors: age, BMI, ASA classification, underlying disease, coagulation status (INR, platelet count, anticoagulation use), history of previous lines, thrombus, stenosis, or anatomical variance/difficulty, and indication for the line (antibiotics, chemotherapy, other).Procedure factors: type of line (PICC, CVC, cordis), insertion site and side, number of lumina, number of attempts, procedure duration, level of procedurist (anesthesiologist, PA, anesthesia nurse, resident, other), and safety score (documentation of ECG guidance, ultrasound guidance, guidewire check, monitoring of SpO2, BP, ECG, respiration, and other safety measures).Health system outcomesCumulative radiation exposure per patient from post-line CXRs.Costs:direct (imaging, staff time) indirect (treatment delays, additional bed time).Personnel time: clinician, nursing staff, supportive staff and radiographer minutes per insertion episode.	—

Measure

Time frame

Safety and diagnostic yieldIncidence of malposition and pneumothorax in the cohort, including how often these events were already suspected or identified clinically or by bedside ultrasound/IC-ECG before CXR.Tip accuracy by reference standard: concordance between IC-ECG/targeted US and CXR (discrepancy rate).Complications categorized as immediate, early (<24h), and late (<7 days): hematoma, hemothorax, pneumothorax, arterial puncture, air aspiration, unsuccessful placement, infection, venous thrombosis, line occlusion, and others.Repeat imaging rate: need for additional imaging (repeat CXR or chest CT) related to line placement.Workflow and efficiencyTime to “line ready for use”: defined as the interval from documented start of the procedure in the EHR (HiX) to administration of the first dose of medication via the line (in hours).Delay attributable to CXR: insertion completion ? CXR order ? CXR acquisition ? report release ? line usability.Patient and procedure factorsPatient factors: age, BMI, ASA classification, underlying disease, coagulation status (INR, platelet count, anticoagulation use), history of previous lines, thrombus, stenosis, or anatomical variance/difficulty, and indication for the line (antibiotics, chemotherapy, other).Procedure factors: type of line (PICC, CVC, cordis), insertion site and side, number of lumina, number of attempts, procedure duration, level of procedurist (anesthesiologist, PA, anesthesia nurse, resident, other), and safety score (documentation of ECG guidance, ultrasound guidance, guidewire check, monitoring of SpO2, BP, ECG, respiration, and other safety measures).Health system outcomesCumulative radiation exposure per patient from post-line CXRs.Costs:direct (imaging, staff time) indirect (treatment delays, additional bed time).Personnel time: clinician, nursing staff, supportive staff and radiographer minutes per insertion episode.

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Countries

Netherlands

Contacts

Public ContactM Bieze

Erasmus MC, Universitair Medisch Centrum Rotterdam

secretariaat.anesthesiologie@erasmusmc.nl0107040704

Outcome results