Central Line Placement

Table of Contents

Table of Contents

Published February 2021

Samantha King, MD
Daniel Gergen, MD
Expert review – pending

Objective(s)

  1. Identify left and right central venous catheters (CVCs) on a chest x ray and the appropriate location of their placement

Teaching Instructions

Plan to spend 5-10 minutes familiarizing yourself with the animations of the PowerPoint and the key findings of this chest x-ray.

Present the image either by expanding the window (bottom right) in a browser or downloading the PowerPoint file (downloading is recommended).  Have the image pulled up in presenter mode before learners look at the screen to avoid revealing the diagnosis.  Ask a learner to provide an overall interpretation.  Then advance through the animations to prompt learners with key questions and reveal the findings, diagnosis, and teaching points.

Instructions: Ask a leaner to provide an overall interpretation.  Advance using the arrows or scroll wheel on the mouse reveal subsequent questions with answers and graphics.  You can go back to prior graphics and questions by using the back arrow or scrolling back on the mouse wheel. 

Official CXR Read: The right IJ dialysis catheter and left central venous catheter terminate in the distal superior vena cava. The endotracheal team terminates above the level of the carina. An esophageal probe and orogastric tube is present.

Continued edema with bibasilar opacities. Small pleural effusions. No pneumothorax. Dilated bowel.

Diagnosis: left lower lobe pneumonia, non-specific bowel dilation

Presentation Board

Take Home Points

  1. An internal jugular central venous catheter should terminate in the distal superior vena cava, approximately at the level of the carina.

  2. Dialysis catheters are thicker and less flexible than triple lumen catheters, and therefore preferentially placed on the right (straighter trajectory).

References

Goodman LR. The Air Bronchogram Sign. Feldman's Principals of Chest Roetgenology. Fifth Edition. Elsevier, 2021, pp 112-125.

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