This patient's right subclavian CVL is not in good position, with the tip directed upward into the internal jugular vein. There are also bilateral chest tubes, with side holes projecting in good position. This CVL needs to be repositioned.

When checking the position of a central line (CVL), the tip should be in the superior vena cava (SVC). The SVC is not immediately obvious on radiographs, but if you know the anatomy as shown in the labeled image above, you can figure out where the tip of a CVL should be. The upper end of the SVC is where the two brachiocephalic veins join, which is usually close to the level of the aortic arch. The lower end of the SVC is usually visible as a change in curvature of the right margin of the mediastinum, just at the top of the smooth curve of the right atrium, as shown. This lower point of the SVC is called the cavo-atrial junction (CAJ).