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CXR: Central line position

Chest x-rays are commonly obtained after central line placement to (1) exclude complications (such as pneumothorax, malposition, and kinking), and (2) confirm adequate placement. While the optimal location for the catheter tip is controversial, many guidelines suggest the tip to be placed outside of the pericardial sac to limit the risk of cardiac tamponade. The carina on plain chest x-rays is above the pericardial sac, and as such, the tip of the catheter in right-sided catheters should typically be above the carina. In left-sided central catheters, the catheter tip enters the superior vena cava at a more oblique angle as it transverses across the left brachiocephalic vein. Therefore, left-sided central catheter placements are at greater risk of vascular perforation given the angle of the catheter tip in relation to the wall of the SVC. As such, some authors suggest that these catheters may be safer in the distal SVC or right atrium.


  1. Schummer W, Schummer C, Schelenz C, Schmidt P, Fröber R, Hüttemann E. [Modified ECG-guidance for optimal central venous catheter tip positioning. A transesophageal echocardiography controlled study]. Anaesthesist. 2005;54(10):983-990. Link
  2. Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med. 2007;33(6):1055-1059. Link
  3. Venogopal AN, Koshy RC, Kosky S. Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature. Journal of Anaesthesiology Clinical Pharmacology. 2013;29(3):397-400. Link
  4. Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000;85(2):192-194. Link