Table 1.

Identifying lines and tubes and other devices

Endotracheal tubes

Safe level 5 cm from carina (T4-T5 interspace), minimum distance 2 cm

Nasogastric tube

Ideally the distal duodenum

CVP lines

Ideally placed between proximal venous valves of the subclavian or jugular veins and the right atrium. Jugular venous placement has lower complications.

Swan ganz catheter

The tip is wedged into the distal pulmonary artery.

The balloon is deflated once the pressure is taken, and the tip is pulled back to the main pulmonary artery.

The tip of the catheter located within the mediastinal shadow indicates correct placement.

The thoracostomy tube

The last side-hole in a thoracostomy tube can be identified by an interruption in the radiopaque line.

This interruption in the radiopaque line should lie within the thoracic cavity, if not and or with evidence of subcutaneous air, a misplaced tube is suspected.

Incorrectly placed tubes for empyemas may delay drainage and result in loculation of the purulent fluid.

Thoracostomy tubes placed within pleural fissures often cease to drain when the lung surfaces become apposed.

Cardiac pacemakers

The tip of the cardiac pacemaker should be at the apex of the heart, and there should be no sharp angulations along the length of the pacemaker wires.

The lateral radiograph should show the tip imbedded within the cardiac trabeculae.

For correct placement to have occurred, the tip should appear 3 to 4 mm beneath the epicardial fat pad.

A tip that appears to be placed beyond the epicardial fat stripe may have perforated the myocardium.

Cardiac pacers placed within the coronary sinus appear to be directed posteriorly on the lateral chest radiographs.