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Lines and tubes in the chest


End of CVC is in the superior vena cava,ideally at the junction with RA,this position decrease the risk of tip thrombosis and dysarthmyias... Look for complications as pneumothorax 

Pulmonary artery catheters: ideally 5 – 8 cm beyond the bifurcation of the main pulmonary artery in either the R or L pulmonary artery,not to extend beyond the pulmonary hilum on CXR.

 ET tube: neck extension and flexion can make a tube move up to 3 cm. In neutral position tube should be 2- 3 cm above the carina...remember flexion =further ,extension=exit 

Tracheostomy tube: Tube tip should be at the level of T3. Exclude complications of pneumothorax, pneumomediastinum and subcutaneous emphysema..tracheostomy tube dose not move with neck movement 

 Pleural tubes: check all side holes are within the thorax


Intra-aortic balloon pump: ideal position of the tip is just distal to the origin of the L subclavian artery on TOE, or tip in 2nd intercostal space just above the left main bronchus. If advanced not too far it may occlude the left subclavian artery and if too distal may occlude branches of the abdominal aorta. 
Umbilical venous catheters – can be utilized in neonatal resuscitation, tip should be located in the IVC beyond the ductus venosus but proximal to the RA 
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