It is prudent for the clinician to keep in mind that occasionally a chest radiograph needs to be obtained when patients develop symptoms during a procedure, or when the procedure was laborious, took many punctures, or was associated with IC ECGs of questionable quality. The question of how quickly the procedure can be performed has been thoroughly researched,3–9,15–16
and the consensus is that this procedure can be completed rapidly, without any additional equipment, practically eliminating the need for a confirmatory chest radiograph with a related time delay of approximately 1 h and thus preparing the patient for immediate HD, which occasionally has to be implemented expeditiously. In terms of subsequent monitoring, repeating the IC ECG is rarely required. SCVCs are securely anchored in their position, and only peripherally inserted catheters are associated with migration deeper into the RA or right ventricle.10,17
Nevertheless, on the rare occasion when this happens due to deficient stabilization of the catheter (eg, due to disruption of the skin sutures), an IC ECG can be obtained, can be checked to confirm that the morphology of the P wave has changed from a negative deflection to a positive/negative or completely positive one, the SCVP can be withdrawn a few centimeters, and the IC ECG can be repeated, with the presence of only a negative P-wave deflection in the final tracing needed to confirm repositioning. Even in such an instance, a chest radiograph is unnecessary.