Where is the appropriate position for an internal jugular CVC tip on CXR?

  • The most commonly used x-ray landmark is the level of the carina 1:
    • Origin of the Superior vena cava 1-2cm above
    • Pericardial reflection lies 1-2cm below
    • Tip should lie within the boundaries
  • Cavo-atrial junction usually lies two vertebral bodies below the carina:
    • Above this may be an acceptable position for L sided lines to ensure they lie parallel or haemodialysis catheters to optimise flow
Correct positioning for tip of central line (CVC) on chest x-ray (CXR)