Chest X-ray - Tubes
CV Catheters - Complications

Key points

  • A chest X-ray may demonstrate immediate complications following CVC placement, or incorrect positioning
  • Some incorrect catheter positions are associated with long term complications

A chest X-ray taken after central venous catheter placement can identify immediate complications such as pneumothorax or pneumomediastinum.

The X-ray may also be used to identify incorrect positioning and, therefore, help reduce the risk of delayed complications such as pericardial tamponade or vessel wall erosion.

Immediate complications

Complications such as pneumothorax and surgical emphysema may arise from traumatic placement.

Iatrogenic pneumothorax

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Iatrogenic pneumothorax

  • This right subclavian catheter is adequately positioned with its tip in the superior vena cava
  • Positioning was complicated by pneumothorax due to pleural injury

Incorrect positioning

If catheters are not inserted far enough they may be located in the jugular, subclavian, or brachiocephalic veins.

Catheters inserted too far may enter the right atrium.

CVC in left brachiocephalic vein

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CVC in left brachiocephalic vein

  • The tip of this catheter is projected over the left brachiocephalic vein rather than the SVC (superior vena cava)
  • A nasogastric tube is also in situ (not fully imaged)

Catheter in right atrium

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Catheter in right atrium

  • This peripherally inserted central catheter (PICC) was aimed to be inserted with its tip at the level of the cavo-atrial junction (the height of two vertebral bodies below the carina)
  • The PICC has been inserted too far with its tip in the right atrium (RA)
  • Note: Some large haemodialysis catheters are designed to be placed with their tip in the RA

Horizontal positioning in SVC

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Horizontal positioning in SVC

  • Catheters placed via a left-sided approach are prone to being positioned nearly horizontally rather than vertically within the SVC
  • Catheters which contact the lateral wall of the SVC in this way may cause vessel erosion if positioned long term, and should therefore be placed so the tip is orientated vertically (see previous page)
  • A nasogastric tube is also in situ (not fully imaged)

Internal jugular catheter - misplaced

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Internal jugular catheter - misplaced

  • CV catheters may take an incorrect course and end with their tip in completely the wrong place
  • This left internal jugular catheter has entered the left subclavian vein
  • The catheter needs to be repositioned
  • Note also the ET tube, the external cardiac monitoring wire, and the lung shadowing - due to pulmonary oedema in this case