Prevalence of Pneumothorax Following Right-Heart Catheterization: Is Routine Post-Procedure Chest Radiography Indicated?

From the 2018 HVPAA National Conference

Christopher Centonze (University of Michigan), Ella Kazerooni (University of Michigan), Matthew Davenport (University of Michigan)

Background

Standard practice at Michigan Medicine is to obtain a routine chest radiograph on all outpatients following outpatient right heart catheterization and endomyocardial biopsy. This is done because of the theoretical possibility of a pneumothorax from an internal jugular vein approach.

Objectives

To determine whether routine post-procedure chest radiography is indicated to exclude pneumothorax following outpatient right heart catheterization and endomyocardial biopsy using an internal jugular vein approach.

Methods

This HIPAA-compliant retrospective quality improvement cohort study was approved by the institutional review board. All outpatient subjects (n=6,073) who underwent routine post-procedure chest radiography following right heart catheterization and endomyocardial biopsy in one health system from January 1, 2010 to July 1, 2017 were identified by electronic medical record query using current procedural terminology (CPT) codes. The prevalence of pneumothorax was calculated by coded review of chest radiography reports. Pneumothorax size and clinical outcomes were determined. 95% confidence intervals (CI) were calculated.

Results

Most (99% [99/100 of a random sample]) right-heart catheterizations were performed using an internal jugular vein approach. The prevalence of pneumothorax by post-procedure chest radiography was 0.1% (7/6,073; 95% CI: 0.05-0.24%). Three of the seven pneumothoraces were confirmed within 1 hour to be false positives (i.e., no pneumothorax), resulting in a real pneumothorax rate of 0.06% (4/6,073; 95% CI: 0.00-0.2%). The remaining four pneumothoraces were less than 1 cm. No chest tubes were placed and there was no unexpected prolongation in length of stay.

Conclusion

Pneumothorax following right-heart catheterization utilizing an internal jugular vein approach is rare and usually clinically insignificant. Routine post-procedure chest radiography in this setting is not warranted.

Implications for the Patient

Elimination of routine post-procedure chest radiography will eliminate false positive results, reduce radiation exposure, and reduce costs.