Upper extremity insertion: Place the tip in the lower 1/3 of the Superior Vena Cava close to the junction above the right atrium.

Lower extremity insertion: Place the tip in the Inferior Vena Cava above the diaphragm and below the right atrium.

ONGOING DOCUMENTATION OF CATHETER TIP LOCATION:

• Obtain chest x-ray at the time of insertion.

• Verify new position if the placement is adjusted (see 23 under insertion technique).

• When there are clinical changes that could be consistent with complications of the catheter (i.e. increase in respiratory or cardiovascular distress, unusual location of edema), obtain an X-ray (with contrast if needed) to check catheter tip placement.

• Growth of the infant. If there have been no recent x-rays for other indications, obtain one approximately every two weeks to confirm tip location. Contrast may be needed (see tep 21 under insertion technique .)

• Identify the catheter tip on x-rays done for other indications. Insertion depth increases when the arms are extended above the head. See step 22  under insertion technique.