CLINICAL DATA: Assess central catheter placement.

PORTABLE AP SEMIERECT CHEST (9:30 AM):

Comparison is made to 10/21/91. The central venous catheter has been inserted via a left subclavian vein approach. The tip of the catheter is somewhat difficult to delineate on the film. I can follow the catheter down to the floor of the right atrium. Again, there is evidence of pulmonary vascular congestion and pulmonary edema, without significant interval change. The left peripheral edema has improved. The patient has developed left lower lobar atelectasis. There is a small right pleural effusion.

CONCULSION:

CHF persists. Left lower lobar atelectasis. The tip of the central venous catheter cannot be located on the film but is likely at the floor of the right atrium. No pneumothorax.

Robert E. Shepherd, M.D.