Suboptimally placed lines and tubes on chest x-ray

Case contributed by Dr Matthew Lukies


Post surgery for cardiac tamponade, to assess the position of lines and tubes.

Patient Data

Age: 55 years
Gender: Female

Lines and tubes:

  • The end of the endotracheal tube is projected around 1cm above the carina. This should be retracted approximately 3 cm.
  • The nasogastric tube is seen curling back in the mid esophagus and proceeding superiorly, with the tip and side hole not visualized. This should be replaced.
  • The left internal jugular central venous catheter is seen to curl back with its tip projected superiorly in the internal jugular vein. This should be replaced.
  • There are two appropriately positioned chest drains projected in the anterior and superior mediastinum.

Other findings:

The prosthetic heart valve ring and surgical clips are noted.


Case Discussion

The optimal position for an endotracheal tube is with the tip 3 - 7 cm above the carina.

The optimal position for a nasogastric tube is with the tip (and side hole) in the stomach well below the diaphragm, at least 10 cm beyond the gastro-esophageal junction.

The optimal position for an internal jugular central venous catheter is with the tip in the superior vena cava or at the cavo-atrial junction.

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Case information

rID: 43299
Published: 4th Mar 2016
Last edited: 13th Oct 2019
System: Chest
Inclusion in quiz mode: Included

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