A chest x-ray is ordered to confirm the placement of a central venous catheter. The tip of the catheter should be in the:

Superior vena cava.

Explanation

•A central venous catheter may be placed in a large vein in the neck, arm, or groin or through the chest, but the tip of a central venous catheter should be in the superior vena cava.

•If the CVC tip is situated high up (in the subclavian vein), this can cause vessel wall erosion. If it is very low (in the right atrium), it can cause arrhythmias and damage to the tricuspid valve.

•Central venous catheters are indicated when peripheral veins are inaccessible or when irritating hypertonic fluids or vasoactive drugs need to be administered. They also allow incompatible medications to be given through a multi-lumen catheter, hemodialysis, hemodynamic monitoring, and for rapid infusion of resuscitation fluids.

•Central venous catheters can be lifesaving but are associated with complication rates up to 15%.

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