Pediatric Radiology > Chest > Introduction > Tubes and Lines

Tubes and Lines

The ideal position of the endotracheal tube is in the mid trachea, 1.2 cm below the vocal cords and 2.0 cm above the carina. This is usually at the level of the inferior border of the head of the clavicle.

Chest tubes are ideally positioned anterior and apical for treatment of pneumothorax. It may be necessary to obtain a second view such as a cross table lateral to determine if the chest tube is anterior or posterior. The chest tube should be positioned posterior and inferior for drainage of pleural fluid.

Peripherally inserted central catheters (PICC) should terminate in the SVC if placed in the upper extremity or in the IVC within 1 cm of the diaphragm if placed in the lower extremity.

Umbilical arterial catheters (UAC) are differentiated from umbilical venous catheters (UVC) by the initial downward course from the umbilical insertion into the internal iliac artery. UVC's will extend immediately superior from the umbilicus. The UVC tip should be positioned within 1 cm of the diaphragm for ideal placement in the IVC. The UAC should be positioned below L2 to prevent mesenteric or renal complications. Another school of thought is to keep the UAC above the diaphragm in the thoracic aorta.

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