AAP Paper
Radiation exposure and safety practices during pediatric central line placement

https://doi.org/10.1016/j.jpedsurg.2015.03.022Get rights and content

Abstract

Purpose

Pediatric surgeons routinely use fluoroscopy for central venous line (CVL) placement. We examined radiation safety practices and patient/surgeon exposure during fluoroscopic CVL.

Methods

Fluoroscopic CVL procedures performed by 11 pediatric surgeons in 2012 were reviewed. Fluoroscopic time (FT), patient exposure (mGy), and procedural data were collected. Anthropomorphic phantom simulations were used to calculate scatter and dose (mSv). Surgeons were surveyed regarding safety practices.

Results

386 procedures were reviewed. Median FT was 12.8 seconds. Median patient estimated effective dose was 0.13 mSv. Median annual FT per surgeon was 15.4 minutes. Simulations showed no significant difference (p = 0.14) between reported exposures (median 3.5 mGy/minute) and the modeled regression exposures from the C-arm default mode (median 3.4 mGy/minute). Median calculated surgeon exposure was 1.5 mGy/year. Eight of 11 surgeons responded to the survey. Only three reported 100% lead protection and frequent dosimeter use.

Conclusion

We found nonstandard radiation training, safety practices, and dose monitoring for the 11 surgeons. Based on simulations, the C-arm default setting was typically used instead of low dose. While most CVL procedures have low patient/surgeon doses, every effort should be used to minimize patient and occupational exposure, suggesting the need for formal hands-on training for nonradiologist providers using fluoroscopy.

Section snippets

Methods

Approval was obtained from the local institutional review board for this retrospective study (study number 042013-063). All fluoroscopically guided central venous access procedures performed on pediatric patients by 11 surgeons at a single institution over the calendar year 2012 were analyzed through query of the electronic medical record system. All surgeons had completed a formal pediatric surgery fellowship and had been staff physicians for longer than 1 year at the time of the study.

Results

386 CVL procedures were reviewed on 325 patients of whom 46 had repeat procedures. Patient ages ranged from newborn to 22 years. The median patient age was 4 years (8 months, 11 years [IQR]). Of these cases, 18% had incomplete Ka,r exposure data; however, all FT data were collected. FT per procedure ranged from less than 1 second to 8.1 minutes with a median of 12.8 seconds (5.5, 29.5 seconds [IQR]). The range of entrance exposure per procedure was 12 μGy to 37.9 mGy with a median of 0.72 mGy (0.32, 2.12 

Discussion

Our investigation examined the ionizing radiation exposure to patients and surgeons as well as radiation safety practices during pediatric fluoroscopic CVL placement. We found that the majority of CVL procedures reviewed had low patient exposure with an FT of less than 15 seconds, entrance exposures less than 1 mGy, and a median patient effective dose of 0.13 mSv. One mGy is the equivalent of 10 chest x-rays in an adult or 17 in a newborn [6]. There was one case that extended beyond 8 minutes of FT

Acknowledgements

We appreciate the support of Dr. Steven E. Wolf, Mary A. Wallace, and Rachel Renkes.

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Research reported in this publication was supported by the National Institute for General Sciences of the National Institutes of Health under award number T32GM008593.

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