This situation exemplifies two additional aspects of central line placement. First of all,the statement "line OK to use" or "line in good position" is useless. How does a rad know that a line is OK to use? OK to use means not just with tip in proper position but also with good blood return,not plugged/ruptured/defective,not stuck through an artery into the vein,etc,etc. Also "in good position" means different things to different people. Define "good". "Good" for a knowledgeable interpretter of line CXR's means "lower 1/3 of SVC at or near the CA juncture" (SIR,AVA,INS). "Good" for anyone else might be anywhere from rt ventricle to contralateral IJ to aortic arch (seen 'em all). What I want to know when I read a CXR report for line placement is where the tip lies anatomically,e.g. "lower SVC 1.5 cm above CA juncture". That,plus MY assessment of the line's patency and function is what makes a catheter "OK to use".
The second issue is the importance of getting a repeat film after a significant line adjustment.A few years ago,there was a tragic case in Pennsylvania. A neonate had a line placed and the initial reading was that it was too low and needed to be pulled back a few cm. Either no one actually adjusted the line or there was no repeat film,and the line eroded through the atrium. Results-ruptured heart--tamponnade--dead infant--big lawsuit. Moral of the story? Reshoot after an adjustment.