Approach to Proper Positions for Tubes and Lines

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Approach/Discussion:
Umbilical Arterial Catheter (UAC) Hi Positioning - Courses to left side of spine on the AP film and posteriorly on lateral film. The tip projects between T4 (ductus arteriosus) and T10/11 (celiac axis).

Umbilical Venous Catheter (UVC) - Courses to right side of spine on the AP film and anteriorly on lateral film. The tip projects over right atrium. The UVC courses from umbilical vein to left portal vein to ductus venosus to either hepatic vein or IVC and then into right atrium. The UVC tip should not be within the liver or the right atrium.

Central Venous Line (CVL) - tip in superior vena cava

Endotracheal Tube (ETT) - Below the thoracic inlet and above the carina. The ETT shifts with head position. As the head is flexed forward the ETT appears to lie lower in the trachea than it does, and as the head is extended posteriorly the ETT appears to lie higher in the trachea than it does.

ECMO arterial-venous (AV) - The tip of the arterial catheter should be in the aortic arch and the tip of the venous catheter should be in the right atrium. The exact position of these tips may be difficult to determine as they are often not radiopaque.

ECMO venous-venous (VV) - The tip of the venous catheter should be in the right atrium pointing towards the tricuspid valve. The exact position of this tip may be difficult to determine as it is often not radiopaque.

Levels of the Vascular Axes

Aortic Arch - T4

Celiac axis - T10-T11

SMA - T11

Renal arteries - T12-L1

IMA - L1

Iliac bifurcation - L3

References:
See References Chapter.

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