2.6 Tubes and Lines in Thoracic Radiology Flashcards
List 9 possible lines or tubes you may find on a CXR.
What is an endotracheal tube used for?
What is the correct positioning of an ETT on a CXR?
Used as temporising measure for patients who are unable to maintain their own airway.
Distal tip should be located approximately 3cm - 5cm above the carina.
Carina is sometimes difficult to spot - so you can look at the aortic knob, the bottom edge of the aortic knob is usually the same level as the carina.
Neck flexion and extension can help move the tip 2cm up or down.
Where is the ETT?
It is in the R main bronchus!
It needs to be readjusted immediately before it can be used.
What is a tracheostomy tube?
What is the correct positioning for it?
What are possible complications should you look for?
Tracheostomy is a semi-permanent tube in the trachea to help with breathing.
Its tip should be located 3cm above the carina (pictured).
Possible complications include tracheal perforation (acute) and stenosis (chronic).
Compare and contrast the 1) use, 2) placement and 3) complications of the two major feeding tubes, the NGT and Dobbhoff tubes.
What is the correct positioning of an NGT?
Should be in the stomach.
What is the correct placement of the Dobhoff tube?
The duodenum. Note that in this picture, the tube follows the curve of the duodenum.
What is a central line? What is it used for?
Describe the correct insertion and placement of a central line.
A central line provides access to the venous system via a larger vessel. It is usually for administration of medications that cannot be given via a smaller peripheral vessel.
The line can be inserted either via the internal jugular (seen coming down from neck on CXR) or the subclavian vein (seen tracing under clavicle).
A correctly placed central line should follow the vertebral column down (like the venous system) and be inside the line of the SVC, lateral to the R heart border.
Where is the central line?
Right central line, placed with tip projecting left of midline, due to its entry of the arterial system. It has been mistakenly placed in an artery.
(Note in the anatomical diagram how the SVC does not cross the midline, but the subclavian artery certainly does.)
Name 3 major complications of a central line.
Note the subclavian approach is more likely to cause accidental puncturing of the lung.
What type of central line is this?
This is a Portacath. It has a triangular port for venous access and is usually left in place long-term for chemotherapy.
What is a PICC line?
PICC - peripherally inserted central catheter
What is a Swan-Ganz catheter?
What is it used for and what is the correct positioning?
What are some complications associated with it?
Tip of the Swanz-Ganz catheter enters in via the internal jugular (IJ) or subclavian veins and loops, ending in the the L pulmonary artery.
What is a chest tube?
A tube placed to drain collections of air or fluid in the pleural space.
What is the correct placement of a chest tube?
What are some possible complications of poor placement?
- Chest tube should be placed within the pleural space
- Anteriosuperiorly for pneumonthorax (air rises)
- Posterioinferiorly for effusion (liquid falls)
- The side holes also need to be within the thoracic cavity, if they are not, you may end up with subcutaneous emphysema in the soft tissues
- Poor placement can cause intercostal artery laceration leading to bleeding, or laceration of liver or spleen due to inferior placement
What is a cardiac pacemaker?
What types are there?
A cardiac pacemaker, is a medical device that generates electrical impulses delivered by electrodes to cause the heart muscle chambers to contract and therefore pump blood; by doing so this device replaces and/or regulates the function of the electrical conduction system of the heart.
3 major types:
- Single lead - Electrode in Apex of RV
- Dual lead - Electrodes in Apex of RV, RA
- Triple lead - Electrodes in Apex of RV, RA, coronary sinus
The attached image shows a dual - lead pacemaker in a patient who also has valve replacements.
What is an AICD?
How does it look on a CXR?
AICD - automatic implanted cardiac defibrillator
Used to defibrillate in setting of tachyarrhythmia.
One electrode is in SVC, the second if present is in the RV apex.
How do you tell the difference between an AICD and pacemaker on a CXR?
What common complication of an AICD should you look for?
Leads may fracture. Look for this when checking wellbeing of AICD in CXR.
The ends of the leads are thicker in an AICD compared to in a pacemaker. (Which makes sense, as it needs to deliver a bigger shock.)
What is a cardiac intraaortic balloon pump?
How does it look on the CXR?
What is the correct placement of an intra-aortic balloon pump?
What are the complications of incorrect placement?
Usually only the metallic end of the pump is visible, in the aorta.
