Interpretation of the radiograph:
If a line or a tube is visible on a film it is important to establish it is in the correct position and to identify any complications that may have arisen as a result of its insertion.

 

Follow these steps for each line or tube visible on the film:
1.          Follow the line along its whole length and ensure it is not a object lying outside the patient for example oxygen tubing.
2.          Establish where the end or tip of the line / tube is most likely to lie using your knowledge of anatomy. Decide if it is in the correct position.
3.          If the line/tube is difficult to visualise on the radiograph it may be necessary to enlarge or change the window levels of the image.
4.          Look for any complication of its insertion eg a pneumothorax, collapsed lung etc

 

Examples
Case 1   >>          Tubing on the surface of the patient
Case 2   >>          Enlarge the image to visualise the tip of a line
Case 3   >>          Window the image to visualise the tip of a line
Case 4   >>          Use your knowledge of anatomy to determine position
Case 5   >>          Identify complications for example a collapsed lung

 

Case 1:

 

 

This chest radiograph shows the tubing from an oxygen mask lying on the surface of the patient. This should not be mistaken for a catheter or line within the patient. Many different artefacts are seen on the patients skin or clothing which can be misinterpreted as a catheter. (ECG leads are another common example).

 

If you 'follow' the line along its whole length it is often easy to determine if it lies outside the patient.

 

 

 

 

Case 2:

 

 

This chest radiograph shows a PICC line ('Peripherally Inserted Central Catheter).

 

These catheters are fine bore and the tip is often difficult to visualise. Enlarging the film helps to identify the tip which ideally should lie in the distal superior vena cava or at the junction of the right atrium and superior vena cava.

 

 

 

 

 

Case 3:

 

 

This chest radiograph shows a nasogastric tube.

 

The tip of the tube and distal tube are poorly visualised on this film but if the window levels are adjusted the distal tube is seen clearly. The tip of the tube can not be seen as it is below the area covered by the radiograph.

 

 

 

 

 

Case 4:

 

 

This chest radiograph shows another PICC line - the line is on the right side.

 

As stated in case 1 the tip of the line should lie in the distal SVC or at the junction of the SVC and right atrium. Clearly the tip of this line is in an incorrect position (enlarge the image to see the end of the line).

 

The line should pass through the subclavian vein, into the right brachiocephalic (or innominate) vein and into the SVC. Knowledge of the anatomy of the veins of the thorax indicates that the line has passed from the subclavian vein into the right internal jugular vein rather than the brachiocephalic vein.

 

 

 

 

 

 

 

Case 5:

 

 

This chest radiograph shows an endotracheal tube and a nasogastric tube.

 

The endotracheal tube is too low and lies in the right main bronchus - it should lie above the carina. The position of the endotracheal tube is causing obstruction of the left main bronchus and collapse of the left lung. The upper lobe right bronchus is also likely to be obstructed as the right upper lobe has also collapsed.