Spaghetti junction

Multiple tubes and lines. In the ICU setting, it is not unusual to encounter patients with multiple indwelling hardware devices, each of which must be carefully checked for appropriate position and potential complications. In this example, the tip of the endotracheal tube (red arrow) is in expected position above the carina (in the neutral position, its tip should be approximately 5 cm above the carina, although it can move several centimetres depending on whether the patient’s neck is flexed or extended). There are bilateral internal jugular venous lines (white arrows), and there is a pulmonary arterial (Swan-Ganz) catheter looping through the right ventricle and pulmonary outflow tract (yellow arrow). The patient also has a portacath (orange arrows).