Confirming Central Venous Access Position
February 15th, 2021
Overview
A wide range of large bore and central catheters are used in clinical practice. The chest x-ray is used to confirm that such catheters are in the correct position and are safe to use.
Central Venous Catheters (CVCs)
A central venous catheter is a large bore catheter inserted into a large vein for the purpose of central venous access.
A CVC inserted via the subclavian or internal jugular vein should be within the SVC i.e. angled downward toward the right heart border, but not in the right atrium.
Example
- A right internal jugular CVC within the superior vena cava
![A right internal jugular CVC within the superior vena cava]()
Indications for Central Venous Catheter
- Administration of certain medications - high-dose potassium, vasopressors, TPN, certain chemotherapy
- Haemodynamic monitoring - central venous pressure
- Large transfusion requirement
PICC Lines
A peripherally inserted venous catheter (PICC) line is a small but long line inserted into the arm and advanced into the central veins.
A PICC line should be within the SVC i.e. angled downward toward the right heart border, but not in the right atrium.
Examples
- A right-sided PICC line at the cavoatrial junction
![A right-sided PICC line at the cavoatrial junction]()
- A left-sided PICC line at the cavoatrial junction
![A left-sided PICC line at the cavoatrial junction]()
- A right-sided PICC line seen within the right atrium
![A right-sided PICC line seen within the right atrium]()
Indications for PICC Line
- Administration of certain medications - high-dose potassium, vasopressors, TPN, certain chemotherapy, long-term antibiotics
- Difficult peripheral venous access - with need for frequent blood samples
Vascaths
A vascath is a wide bore catheter usually inserted into the subclavian or internal jugular vein. It may be non-tunnelled (short-term) or tunnelled (longer term).
A vascath should be within the SVC i.e. angled downward toward the right heart border, but not in the right atrium.
Examples
- A non-tunnelled vascath at the cavoatrial junction
![A non-tunnelled vascath at the cavoatrial junction]()
- A tunnelled vascath
![A tunnelled vascath]()
Indications for Vascath
- Dialysis
- Plasmapheresis
Portacaths
A portacath is a subcutaneous port with a line inserted into the subclavian vein, usually for long-term administration of medications such as chemotherapy.
Example
- A portacath inserted for chemotherapy in a patient with non-small cell lung cancer
![A portacath inserted for chemotherapy in a patient with non-small cell lung cancer]()
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