Simple preoperative radiation safety interventions significantly lower radiation doses during central venous line placement in children

Purpose: The purpose of this study was to reduce radiation exposure during pediatric central venous line (CVL) placement by implementing a radiation safety process including a radiation safety briefing and a job instruction model with a preradiation time-out. Methods: We reviewed records of all patients under 21 who underwent CVL placement in the operating room covering 22 months before the intervention through 10 months after 2013-2016. The intervention consisted of a radiation safety briefing by the surgeon to the intraoperative staff before each case and a radiation safety time-out. We measured and analyzed the dose area product (DAP), total radiation time pre- and postintervention, and the use of postprocedural chest radiograph. Results: 100 patients with valid DAP measurements were identified for analysis (59 preintervention, 41 postintervention). Following implementation of the radiation safety process, there was a 79% decrease in median DAP (61.4 vs 13.1 rad*cm(2), P < 0.001) and a 73% decrease in the median radiation time (28 vs 7.6 s, P < 0.001). Additionally, there was a significant reduction in use of confirmatory CXR (95% vs 15%, P < 0.01). Conclusion: A preoperative radiation safety briefing and a radiation safety time-out supported by a job instruction model were effective in significantly lowering, the absorbed doses of radiation in children undergoing CVL insertion. Type of study: Case-control study. (C) 2018 Elsevier Inc. All rights reserved.