Emergence Teleradiology Line Placement Verification
by X ray

Remember that words overlies or projects over do not necessarily mean that line is in the wrong place. This mean that we are dealing with a 3 dimensional object in a single plain and it is therefor, impossible to say exactly where the central line is. There, the following are beneficial.

  • To determine exact placement of any central line or tube it is always preferable to have 2 orthogonal projections. However, it is not always possible to obtain such images in mobile imaging.
  • For PICC line placement recommend AP chest and a 2nd oblique AP view with the contralateral (opposite) shoulder forward.
  • For central lines such as subclavian and IJ catheters it is preferable to perform an AP and a lateral chest x ray. Try to perform the AP film during expiration.
  • For nasogastric tubes visualization from the level of the carina to the bottom of the stomach is necessary. This can often be accomplished with one view if perform a high AP abdomen. However, if the patient has abdominal pain will need second AP for lower abdomen.
  • For gastrostomy tube it is imperative that we perform one of the first two methods. Otherwise, a tube under the skin (in the wrong position) would look identical to a tube in the stomach.
  1. Inject 20ml of water soluble contrast into G tube. Wait 3-5 minutes and take an AP view to confirm placement. Water soluble contrast poses no significant risk for peritonitis if the tube is in the peritoneum.
  2. Aspirate as much air as possible from the stomach and take AP view. Then inject 300ml of air and take a second AP view.
  3. If cannot perform either of first 2 which are always preferable then can attempt AP and Lateral views of the stomach. However, visualization is not always possible on lateral due to body habitus.

If the nurse is not sure of central line based on radiology report then they should call 1-877-xray-247 to discuss with radiologist.