Name every line and its tip position (cavoatrial junction for most central lines), look for pneumothorax after insertion, malposition into the wrong vein, catheter fracture or pinch-off, fibrin sheath and thrombosis.
Orient first
- Ideal tip: lower SVC or cavoatrial junction (≈ two vertebral bodies below the carina — verify).
- Pinch-off syndrome: subclavian catheter compressed between clavicle and first rib — risk of fracture and embolisation.
- Left-sided lines may cross into a persistent left SVC — a variant, not a malposition.
Acquire the study
- Erect frontal chest radiograph (lateral if uncertain).
The manoeuvre
- Radiograph: trace each line from entry to tip; tip level relative to the carina.
- Pneumothorax at the apex after subclavian or jugular insertion.
- Malposition: contralateral subclavian, internal jugular, azygos, right ventricle.
- Port: catheter kinks, disconnection, narrowing between clavicle and first rib on the radiograph.
What confirms it
- Tip position and complications documented.
What licenses you to exclude it
- A correctly positioned tip without pneumothorax is an uncomplicated insertion.
The classic misread
- Calling a line in a persistent left SVC malpositioned.