[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Radiology](https://durgical.com/en/radiology/) › [Chest](https://durgical.com/en/radiology/areas/chest/) › Lines and tubes on the chest X-ray: where each tip should be # Lines and tubes on the chest X-ray: where each tip should be - Reading After a breathing tube, feeding tube or central line goes in, an X-ray checks where its tip lies; a wrong place can be dangerous. Updated Nov 12, 2026 ## Key points - ETT tip about 5 cm above the carina, head neutral. - CVC and PICC tip: lower SVC or cavoatrial junction. - NG tube: midline, below the diaphragm, tip in the stomach before use. - After a jugular or subclavian line, look for a pneumothorax. ## What it is Many chest X-rays in emergency rooms and intensive care are taken to check a device. Each one has a target and typical wrong places. The endotracheal tube tip should sit in the mid trachea, a few centimetres above the carina, because it moves down when the neck flexes and up when it extends. A central venous catheter from the jugular or subclavian vein, or a PICC from the arm, should end in the lower superior vena cava or at its junction with the right atrium. A nasogastric tube must be confirmed below the diaphragm in the stomach before anything is put through it. The X-ray also looks for the complications of insertion, above all a pneumothorax after a jugular or subclavian line. Always follow the whole course of each device, not just its tip. ## What to check - Endotracheal tube: tip about 5 cm above the carina (roughly 3–7 cm) with the head neutral; the carina usually projects at about T4–T5. - Central venous catheter (jugular or subclavian) and PICC: tip in the lower superior vena cava or at the cavoatrial junction. - The carina is a good landmark for the SVC: the cavoatrial junction lies roughly two vertebral bodies below it. - Nasogastric tube: stays in the midline down the oesophagus, bisects the carina, crosses the diaphragm and turns left; the tip and side holes lie well inside the stomach. - Chest drain: all side holes inside the chest wall, within the pleural space. ## Reading it step by step (and why) - List every device on the film first — it is easy to check one and forget another. - ETT: find the carina, then the tip; measure the gap — too low enters the right main bronchus, too high risks extubation. - ETT too low: look for left lung collapse and right lung overinflation — right main bronchus intubation is the classic error. - NG tube: follow it down the midline past the carina and below the diaphragm — a tube that follows a bronchus is in the airway. - NG tube tip: confirm it is in the stomach, well beyond the gastro-oesophageal junction — side holes in the oesophagus risk aspiration. - Central line or PICC: follow it to the tip and locate it against the carina — a tip in the atrium or a vein in the neck is malpositioned. - After a jugular or subclavian line: look carefully at the apex for a pneumothorax — it is the main early complication. - Look for coils, kinks, loops or a tube in an unexpected vessel — a line crossing to the other side or up into the neck needs repositioning. - Write the position of each device in the report — the team acts on it. ## Common mistakes - Checking only the tip and missing a nasogastric tube that passed through a bronchus into the lung. - Missing a right main bronchus intubation because the left lung collapse was not looked for. - Calling a line in the SVC when it is in the azygos vein, an artery or the opposite brachiocephalic vein. - Forgetting that neck flexion and extension move the ETT tip down and up by a couple of centimetres. ## Next step - Misplaced NG tube in the airway: do not use it; remove it and replace it, then confirm again on X-ray. - ETT in a main bronchus or too high: tell the team at once so it can be pulled back or advanced and rechecked. - Central line tip in the atrium, the neck or an artery, or a new pneumothorax: tell the operator or a senior immediately. - If the tip or the course is unclear, ask the radiologist; an extra view or a contrast check may be needed. ## Test yourself Think of the answer, then tap the question to see it. ## Where should the tip of an endotracheal tube be on a chest X-ray? In the mid trachea, about 5 cm (roughly 3–7 cm) above the carina with the head in neutral position. ## Why is right main bronchus intubation more common than left? The right main bronchus is wider, shorter and more vertical, so a tube pushed too far tends to enter it. ## Where should the tip of a central venous catheter or PICC lie? In the lower superior vena cava or at the cavoatrial junction, roughly two vertebral bodies below the carina. ## What must the X-ray show before a nasogastric tube is used for feeding? A course in the midline down the oesophagus, through the diaphragm, with the tip clearly inside the stomach, not in a bronchus or the oesophagus. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/radiology/lines-and-tubes-on-the-chest-x-ray-where-each-tip-should-be/) ## Connections ## Related 4 - [Reading a chest X-ray step by step](https://durgical.com/en/radiology/reading-a-chest-x-ray-step-by-step/) - [Is this chest X-ray good enough? Projection, rotation, inspiration and exposure](https://durgical.com/en/radiology/is-this-chest-x-ray-good-enough-projection-rotation-inspiration-and-exposure/) - [Pneumothorax on the chest X-ray](https://durgical.com/en/radiology/pneumothorax-on-the-chest-x-ray/) - [Lobar collapse (atelectasis) on the chest X-ray](https://durgical.com/en/radiology/lobar-collapse-on-the-chest-x-ray/) [← All of radiology](https://durgical.com/en/radiology/) Educational content; it does not replace a radiologist's report and is not a clinical instruction. Each study is ordered on the patient's assessment and your institution's protocols. Sources: [Endotracheal Intubation Techniques](https://www.ncbi.nlm.nih.gov/books/NBK560730/) (StatPearls (NCBI Bookshelf), 2023); [Central Venous Catheter Insertion](https://www.ncbi.nlm.nih.gov/books/NBK557798/) (StatPearls (NCBI Bookshelf), 2025); [Peripherally Inserted Central Catheter (PICC) Line Placement](https://www.ncbi.nlm.nih.gov/books/NBK573064/) (StatPearls (NCBI Bookshelf), 2024); [Nasogastric Tube Insertion](https://www.ncbi.nlm.nih.gov/books/NBK556063/) (StatPearls (NCBI Bookshelf), 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/radiology/lines-and-tubes-on-the-chest-x-ray-where-each-tip-should-be/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/radiology/lines-and-tubes-on-the-chest-x-ray-where-each-tip-should-be/