E5222. Optimizing Bedside Vascular Access Using Portable Fluoroscopy: Just-in-Time Support
  1. Gaurav Gopu; Emory University
  2. Kaesha Thomas; Emory University
  3. Judy Gichoya; Emory University
  4. Peter Park; Emory University
  5. Zachary Bercu; Emory University
  6. Elizabeth Krupinski; Emory University
  7. Janice Newsome; Emory University
The objective of this study was to explore the effectiveness of using portable fluoroscopy as a just-in-time support tool for optimizing bedside vascular access. The study aimed to determine how the integration of portable fluoroscopy could enhance the accuracy and efficiency of vascular access device (VAD) placements compared to the conventional method of blind placement, followed by confirmation using portable chest x-rays (CXR).

Materials and Methods:
We conducted a retrospective study in a large academic center to investigate the number of CXRs required to confirm central venous catheter (CVC) or peripherally inserted central catheter (PICC) line placements. We searched for all CXRs with indications of CVC (tunneled and nontunneled) or PICC line placement between 2009 and 2022 and matched them with their corresponding CPT codes per patient. We then extracted the number of CXRs needed to confirm the lines per patient. Patients who required multiple CXRs for a single line were analyzed in-depth. Data analysis was performed using Python, and statistical significance was determined by a p-value of < 0.05.

The analysis encompassed a total of 22,313 CPT codes associated with VAD placements. Among these procedures, a cumulative total of 20,260 CXRs were utilized to validate the correct positioning of the lines. Most patients (88.3%) required only one CXR for confirmation; however, a subset of patients (11.7%) necessitated multiple CXRs to verify line placements. Among the cases requiring multiple CXRs, 88.0% involved two CXRs, 10.8% needed three CXRs, 0.9% demanded four CXRs, and 0.3% required five CXRs. The reasons for multiple x-rays included issues like kinked lines, malpositions in critical veins, and malplacement in various anatomical structures.

The study's findings highlight the potential advantages of incorporating portable fluoroscopy as a support tool during bedside vascular access procedures. The ability to visualize real-time placement using portable fluoroscopy may mitigate complications and lessen the need for multiple CXRs in specific cases. By addressing challenges such as kinked lines or malpositions, this approach can contribute to improved patient outcomes, reduced complications, and enhanced overall workflow efficiency within the healthcare institution.