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301 MEDIMAGE > 8. Tubes/Line positions in DCCM/CVICU > Flashcards

8. Tubes/Line positions in DCCM/CVICU Flashcards

1
Q

what are 3 reasons for learning correct tub/line positions and pathologies

A

MITs are first to view image

misplaced tubes/lines and pathologies can be dealt with sooner before they become life threatening or cause further problems

patients in ICU are critically ill so any further complication could be life threatening or extend their stay

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2
Q

what does an endotracheal tube do

A

endotracheal intubation keeps airway open and protected to give O2/medicine/anesthesia

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3
Q

what does an endotracheal tube act as

A

acts as conduit between airway and ventilator

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4
Q

what does the cuff of an endotracheal tube do inflated to exact pressure and what does it prevent

A

seals trachea for positive pressure ventilation and prevents aspiration

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5
Q

what are 5 types of endotracheal tube

A

oral/nasal
cuffed/uncuffed
double lumen endotracheal tube

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6
Q

what feature of endotracheal tubes allow you to know how far to insert

A

they are all graduated with measurements

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7
Q

endotracheal tubes are inserted past where

A

past vocal chords

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8
Q

where does the pilot balloon of endotracheal tubes lie

A

outside of patient

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9
Q

what does the pilot balloon of endotracheal tubes do

A

indicates what the pressure is of the cuff inside the patient

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10
Q

the cuff of the endotracheal tube on the distal end near tube is inflated at exact pressure to seal what structure and what can it do to the image xrayed

A

seals trachea

left on chest so valve and spring looks like artifact on xray so need to get it out of the way

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11
Q

what happens if the pressure is too low inside endotracheal tubes

A

secretions can bypass cuff and get gurgling noise

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12
Q

what happens if the pressure is too high inside endotracheal tubes

A

can damage vascular structure to trachea

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13
Q

what would happen if you get positive pressure ventilation off ventilator and it didnt have a cuff

A

a lot pressure would come back out of airways and gas exchange wont happen and wouldn’t get inflation of chest to produce gas exchange

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14
Q

how do endotracheal tubes protect airways if patient vomits

A

balloon prevents vomit going into lungs

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15
Q

when intubating patient with endotracheal tube what is used to visualize vocal cords

A

visualize vocal cords with laryngoscope with measurements on side of tube so can slip it down to desired measurement so end of ET tube is at correct place in trachea and not misplaced tube

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16
Q

where does the carina lie

A

between T5-7

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17
Q

what bronchus is more vertical and how is this relevant for misplaced tubes

A

right main bronchus is more vertical than left so misplaced tube often goes down right main bronchus and can block off left vein so can get collapse of left lung or part of the lung and depending on how far they place it can also get collapse of right upper lobe

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18
Q

what is the correct position for endotracheal tubes tips

A

min 2cm, max 4cm from carina

ideal position is 3cm above carina

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19
Q

when you are assessing positioning of tube what position should the head be in and why

A

Make sure head is in neutral position when assessing positioning of tube as if its hyper flexed or extended can move placement of tube

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20
Q

what is a double lumen ETT used for

A

to separate the right lung from the left lung to avoid spillage of blood/pus to unaffected lung and ventilates one lung while they operate on other lung

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21
Q

when are double lumen ETT used

2 situations

A

some thoracic surgeries to collapse one lung and ventilate the remaining lung

or to ventilate each lung independently at different rates inflation pressure or tidal volumes

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22
Q

in a double lumen ETT which lung is operated on

A

operate on the one that is not intubated and can collapse down

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23
Q

what happens if the ETT is placed too high

A

dangerous as its close to the vocal chords and could slip out and be extravated

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24
Q

why do you want to get some neck in ICU patient image to assess position of ETT

A

as it may be placed too high near vocal chords

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25
Q

which main bronchus is the mispositioned ETT more likely to go down and why

A

right as its more vertical than the left

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26
Q

what could malpositioned ETT do to the lung lobe

A

lung lobe could collapse

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27
Q

what are 5 indications/situations that you should do a tracheotomy

A

airway obstruction

need for prolonged intubation

inability to intubate with need for GA

adjunct to major head and neck surgery/trauma management

airway protection (neurologic diseases, traumatic brain injury)

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28
Q

mechanical ventilation up to how many days may be endotracheally intubated

A

up to 10 days

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29
Q

what is favored if mechanical ventilation predicted for greater than 21 days

A

tracheostomy

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30
Q

how is the tracheostomy tube different from a ETT

A

length and shape is different as the tracheostomy tube is shorter and smaller

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31
Q

where is tracheostomy tube located

A

between the 2nd and 3rd tracheal rings

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32
Q

what is used to secure the tracheostomy tube

A

tape/flap attachment on the outside

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33
Q

what is done when the tracheostomy tube is taken out

A

put gauze swab to protect airway but it seals over itself in a few hours

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34
Q

where does the tracheostomy tube tip lie beteween

A

midway or 2/3 between stoma and carina

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35
Q

what are 2 types of Central venous catheters

A

tunneled and non tunnelled

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36
Q

when are tunneled Central venous catheters used

A

longer duration

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37
Q

what are 3 types of tunnelled Central venous catheters

A

hickman
groshong
portacath

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38
Q

when are non tunnelled Central venous catheters used

A

temporary use

such as access lines to administer drugs and fluids

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39
Q

what are 2 types of non tunnelled Central venous catheters

A

CVL and PICC lines

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40
Q

non tunnelled Central venous catheter lines cannulate where

A

the jugular vein in the neck straight down to SVC

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41
Q

tunnelled Central venous catheter lines cannulate where

A

usually cannulate right/left subclavian vein in the neck in surgery and distal end will go into the SVC and the other end will be tunneled under the patients tissue and will come out some distance away from operation location

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42
Q

how long can tunnelled Central venous catheter lines stay in for

A

as everything will be kept clean under the skin and just the port will come out of skin it can stay in for ages even years

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43
Q

where is an alternate area for the cannulation of the Central venous catheter not in the neck region

A

femoral vein in groin

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44
Q

what is the common access site for CVL

A

usually internal jugular vein gets cannulated and goes straight down to SVC

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45
Q

what joint to form the innominate veins

A

internal jugular vein and subclavian vein

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46
Q

what do the 2 innominate veins join to form

A

SVC

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47
Q

in what situation do you want lines in the right atrium

A

only for vascular catheter

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48
Q

what are 5 indications for CVL insertions

A

large venous access for prolonged intravenous therapies

used to administer medication/fluids

obtain blood tests - central venous O2 saturations

administer fluid/blood products for large volume resuscitation

measure central venous pressure

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49
Q

how man ports can non tunneled CVC have

A

single
double
triple
quadruple

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50
Q

what will happen to drugs that arent compatible if they go down the same same port

A

will crystalize

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51
Q

why dont drugs have interactions in multiport non tunneled CVC

A

when it gets into distal end there is a high blood flow so little chances the drugs will mix and will be distributed systemically very quickly

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52
Q

what are syringe pumps used for

A

different drugs are administered through syringe pumps to CVC as some drugs cant be mixed together so are administered through different ports of CVC

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53
Q

what are PICC lines

A

peripherally inserted central catheters

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54
Q

are PICC lines tunneled or non tunneled

A

non tunneled

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55
Q

where are the 3 locations that PICC lines are be placed in

A

ICU
PACU
radiology

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56
Q

what are 4 instances PICC lines are used

A

chemotherapy
parenteral nutrition
infection treatment (eg long term antibiotics)
other medication

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57
Q

what does PICC lines allow patients to do at home

A

allows them to go home after insertion and self administer drugs

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58
Q

are PICC lines diameters large or small

A

small

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59
Q

some medications will block PICC so what else is used instead

A

Hickman catheter used instead

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60
Q

what is the correct placement of right CVL

A

in lower SVC before the right atrium

at the level carina

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61
Q

what is the orientation of the tip of the CVL when inserted as a left sided CVL why

A

parallel to wall of SVC

as its pulsating and can perforate the wall so want tip either further back in the innominate or push through down into SVC (to prevent perforation of the wall)

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62
Q

does a LT or RT CVL require a longer catheter and why

A

left side CVL needs longer catheter due to increased distance to the SVC

63
Q

what is the correct placement of left CVL

A

can have tip below the level of the carina

64
Q

which 4 vessels can misplaced CVLs get into instead of going down SVC

A

internal jugular
innominate vein
opposite subclavian
right atrium

65
Q

if the subclavian CVL line is placed too deep under the clavicle what could happen

A

could puncture the lung resulting in pneumothorax

66
Q

what is a vascular catheter

A

hemodialysis catheter

large calibre catheter used for dialysis in ICU

67
Q

where is the tip of the vascular catheter placed why in there

A

into proximal part of Right atrium where there is high blood flow

68
Q

are hemodialysis catheters large/small diameter and why

A

large diameter to provide high flow

69
Q

what are the 3 types of tunneled lines

A

hickmans
groshong
portacath

70
Q

what are the 7 reasons tunneled lines are used

A 
long term therapy
chemotherapy
blood transfusion
parental nutrition
infection treatment
infection treatment
other medications
71
Q

what is cannulated for tunneled CVC

A

subclavian vein

72
Q

tunneled CVC are inserted under what conditions and how are they imaged

A

inserted under strict sterile conditions in the OR

imaged after placement using II and have a CXR in PACU

73
Q

how is the CVC placed in a tunneled line

A

placed through the insertion site then tunneled under the skin exiting away from the insertion site

74
Q

how are tunneled lines inserted from cannulation site to exit site

A

Cannulate subclavian and feed catheter into the SVC

use forceps to push the rest down under the skin

they exit out under the skin away from operation site

75
Q

what will you see under the skin in a portacath and what can you feel

A

under skin so will see a bulge under the skin

can feel circumference of port with knobbly bits

76
Q

where are injections made in a portacath

A

in the middle

77
Q

how much of the portacath is under the skin

A

completely under the skin

78
Q

how long can portacath CVCs stay under the skin

A

stay in up to 5years

79
Q

how are injections made with a portacath CVC

A

injections are made through the skin into the port

80
Q

ports for portacath CVCs can be accessed up to how many times

A

up to 2000 times

81
Q

why can the tip of a portacath CVC block and how can this be studied

A

tip of portacath can block due to a fibrin blood clot

can be studied in fluro using DSA watching the flow at the tip

82
Q

how does the portacath CVC allow injection but prevent withdrawl

A

Can inject medication but cant withdraw blood from it as it has a clot that acts as a flap

Allows injection into blood but can aspirate and block tube when withdrawing

83
Q

how is a groshong catheter’s tip different from other open ended catheters

A

has a closed rounded tip

84
Q

the valve in a groshong catheter does what during infusion and aspiration and when its not being accessed

A

valve in side wall opens outwards during infusion and inwards during aspiration

valve remains closed when not being accessed

85
Q

the groshong catheter requires flushing with what

what doesnt it need flushing with and why

A

flush with saline

not heparin because of the valve

86
Q

what is a hickman CVC

A

tunneled small bore catheter used for infusion of antibiotics, chemotherapy and nutritional supplements

87
Q

why is a hickman CVC used instead of a PICC line sometimes

A

because of the medication being infused as it wont block as easily as a PICC

88
Q

what has a Swan Ganz catheter have at the tip

A

balloon and sensor

89
Q

where does the Swan Ganz catheter normally lie

A

in the right atrium

90
Q

what is a Swan Ganz catheter also known as

A

pulmonary artery catheter

91
Q

what does a Swan Ganz catheter do - what are its 3 functions

A

measures pressures in the right heart chamber

estimates pressures in left heart chambers

measures CO by thermodilution technique (eg L/min)

basically monitors heart function and blood flow and pressures in heart

92
Q

what is the Swan Ganz catheter used to assess in a patient

A

assess hemodynamic state of patient

93
Q

what does Swan Ganz catheters give info to assess

assesses what 4 things

A

heart failure
sepsis
monitor therapy (ie fluid balance patients and not fluid overload them causing pulmonary edema)
evaluates effects of drugs

94
Q

what is the path of a Swan Ganz catheter

A

through jugular vein -> SVC -> pulmonary valve -> pulmonary trunk

95
Q

the pressures detected along the path of a Swan Ganz catheter shows what

A

pressures change showing what chamber of the heart your in

96
Q

which pulmonary branch does the Swan Ganz catheter normally go in and can it go in the other

A

usually right pulmonary branch but can also go into left

97
Q

where should the tip of the Swan Ganz catheter be

A

no further than the left/right main bronchus

or within 2cm of hilar region

98
Q

when tip of the Swan Ganz catheter is in the pulmonary artery what happens next

A

When tip is in pulm artery it can measure that areas pressure and they can also blow a balloon up and its called a wedge pressure and with high blood flow the balloon will be taken further into the pulmonary tree where it gets smaller and cant go further and sensor says theres no blood flow and measure BP and this is equivalent to the left atrial pressure

99
Q

what is a danger of the swan ganz catheter being taken into the pulmonary tree

A

danger is leaving it in wedge pressure

100
Q

what is the wedge pressure when a swan ganz catheter is used

A

balloon will be taken further into the pulmonary tree from pulmonary artery where it gets smaller and cant go further and sensor says theres no blood flow and measure BP and this is equivalent to the left atrial pressure

101
Q

when inserted the PA catheter generally lies in the ___ branch of the ___ __ but can equally lie in the ___ branch

A

lies in the right branch of the pulmonary artery but can equally lie in the left branch

102
Q

at what times is the swan ganz catheter left in wedge position

A

the PA catheter is only left in wedged position with balloon inflated momentarily while the PAWP is obtained

103
Q

why is it dangerous to leave the swan ganz catheter wedged

A

as it occludes the artery and its pulsating tip can erode through the wall of the vessel and cause pulmonary infarction (block blood supply to that part of the lung) or pulmonary artery rupture

104
Q

the pulmonary artery wedge pressure indirectly measures what pressure

A

left atrium pressure

105
Q

what is needed of the PA catheter is knotted

A

bedside fluoroscopy is sometimes needed to untangle the PA catheter or IR is involved

106
Q

what are the 3 components of a correctly placed PA catheter

A

no kinks/coil/knots in the RA or RV

tip no further than the left or right main bronchus

tip within 2cm of the hilum

107
Q

what are indications for insertion of a pleural or mediastinal drain

A

remove air/blood/fluid from the pleural space and mediastinum

108
Q

what do pleural or mediastinal drains allow

A

allows expansion of lungs and restoration of negative pressure to the thoracic cavity

109
Q

what does the underwater seal of the pleural or mediastinal drains do

A

under water seal prevents backflow of air or fluid into pleural cavity

110
Q

what are the 5 conditions for requiring a chest drain

A

collapsed lung (eg pneumothorax)

lung infection

bleeding around lung

fluid buildup (eg cancer, pneumonia)

surgery - especially lung, heart or oesophageal

111
Q

why do you not lift the underwater drain higher than level of bed

A

as fluid can drain back into pleural cavity or mediastinum

112
Q

the tip of the chest drain should lie where

A

above diaphragm inside the rib cage and superimposed over the lung

113
Q

where should the side holes of the chest drain be inside

A

insider pleural cavity

114
Q

what do broad drains have

A

radiopaque lines in them

115
Q

what are at the end of the underwater chest drains that collects the fluid and what do they do

A

underwater chest drain bottles

they prevent a backflow of fluid or air back into the pleural cavity

116
Q

what are pigtail drains inserted to target

A

target loculated collections

117
Q

are foley type mediastinal drains seen on CXR, why?

A

no as they are less radiopaque and have no opaque marker

118
Q

what are intra-aortic balloon or intra-aortic counter pulsation device do

A

specialized arterial catheter which has a helium filled balloon

119
Q

how and where is the intra-aortic balloon or intra-aortic counter pulsation device inserted

A

inserted percutaneously into the descending aorta via the femoral artery

120
Q

the catheter of a intra-aortic balloon or intra-aortic counter pulsation device is attached to what and what does it do

A

attached to IABP which pumps helium into the balloon

121
Q

the tip of the balloon of intra-aortic balloon or intra-aortic counter pulsation device have what feature

A

tip of balloon has a radiopaque marker which is seen on a CXR for accurate positioning of the balloon

122
Q

what does the balloon of the intra-aortic balloon or intra-aortic counter pulsation device do in diastole

A

balloon inflates when the heart relaxes - diastole - and it pushes the blood towards the coronary sinus and increases coronary arteries perfusion

this increases myocardial oxygen supply

123
Q

what happens to the intra-aortic balloon or intra-aortic counter pulsation device in systole

A

when the heart contracts - systole - the balloon deflates (this deflates the balloon) and the left ventricle doesnt have to push against the resistance of the aortic valve as much and increases CO as it acts as a vacuum when it deflates and the valve opens and it sucks out all the blood which reduces the afterload

the amount of pressure the ventricle must generate to open the aortic valve therefore increasing systemic blood flow and therefore increases CO

124
Q

what type of device is a IABP and what does it help to do

A

type of therapeutic device

it helps to pump more blood if your heart is unable

125
Q

how long does the IABP stay in and what does it do

A

stays in 2-3 days and helps support patient and pump blood of heart

126
Q

what are 7 indications for a IABP

A

LV failure

unstable angina

septic shock

complications to acute myocardial infarction

bridge to heart TX

valvular disease

post cardiac surgery

127
Q

what device is an intra-aortic balloon

A

counterpulsation device

128
Q

where is the intra-aortic balloon placed in and where does it end up

A

placed in the femoral artery and ends up in the descending aorta

129
Q

how long is the intra-aortic balloon

A

around 8inches long

130
Q

what is the intra-aortic balloon shuttled with - what gas and what are the 2 reasons

A

helium

helium is light, inert and shuttles rapidly

as its helium, if the balloon ruptures wont get embolism as it can dissipate quickly and can diffuse rapidly

131
Q

what happens if the intra-aortic balloon is positioned too high into the arch

A

it can interfere with your head and neck blood supply but if its too low, can interfere with renal and mesenteric arteries

132
Q

what is the correct position of the IABP tip

what is the lowest point

A

tip should lie at the level of the carina

lowest point is between the carina and left main bronchus

133
Q

if the IABP is placed too low what can it do

A

can affect the renal artery and mesenteric artery supply

134
Q

IABP patients require how many CXRs

A

require CXR daily

135
Q

why are IABP patients imaged in supine position

A

imaged in supine position because the cannula cannot be kinked

136
Q

why shouldnt you sit the patient up more than 30 degrees for a patient with IABP

A

as it will kink the cannula in the groin

137
Q

when the balloon is inflated on a CXR for IABP, what can it be mistaken for

A

pneumomediastinum

138
Q

what are 5 reasons for a nasogastric tube

A

unable to consume adequate nutrition

impaired swallowing - danger of aspirating

facial or esophageal abnormalities or post surgery

eating disorders

primary disease management

139
Q

what are the 5 functions of a NG tube

A

administer feeds (unconscious ICU pts)

medications administration (eg liquid charcoal used for drug overdose)

facilitate free drainage and aspirations of the stomach contents

facilitate decompression of the stomach

stent the esophagus (eg post perforation of esophagus)

140
Q

what happens when trauma pts are anxious in terms of the stomach - what do these patients need

A

may swallow a lot of air into stomach so needs decompression

141
Q

where do you want the tip of the NG tube to be

A

Want tip to be at least 10cm past the gastroesophageal junction because its got side holes coming down near the tip and don’t want side holes in the esophagus

142
Q

what happens if you put the NG tube too far down

A

could block outlet of stomach either

143
Q

where is the diaphragm in terms of what abdominal junction

A

Gastroesophageal junction is where diaphragm is here

144
Q

what is the path of the NG tube

A

tube follows a straight course down the midline of the chest to the point below the diaphragm

tube doesn’t not follow the path of a bronchus

tube is not coiled anywhere in the chest

tip of tube is below the diaphragm

145
Q

what can aging do to the oesophagus

A

make it more tortuous

146
Q

where are the 7 locations where the NG tube can be mispositioned

A

NGT coiled in nasopharynx or oropharynx

NGT placed in mid/distal oesophagus not stomach or has doubled back up the oesophagus

NGT entered stomach and doubled back up the osephagus

NGT placed to level of the cardia not in fundus

NGT placed at pyloric sphincter obstructing outflow

NGT in duodenum

NGT placed in stomach but tube kinked

147
Q

why do you always need to include the neck on the CXR when evaluating NGT

A

to show an coils in the nasopharynx or oropharynx

148
Q

what is a hiatal hernia

A

stomach is raised and esophagus is shortened so stomach sits behind heart

149
Q

what is situs invertus

A

all body organs are mirrored - other way round to normal

150
Q

what are the 7 indications for nasojejunal tube placements

A

pts at high risk of aspiration

delayed gastric emptying - ICU pt can have reduced gastric absorption/motility

acute pancreatitis

paralytic ileus causing reflux/vomiting

obstructive lesions high in GI tract

partial gastric outlet obstruction

gastric or duodenal fistula

151
Q

what are percutaneous endoscopic gastrostomy tube and when is it used

A

PEG is used when a NGT is contraindicated and there is a requirement for long term enteral nutrition

152
Q

what are 8 indications for taneous endoscopic gastrostomy tubes

A

head injury

cancer - head/nek/oesophagus

burns

facial surgery

dementia

poly trauma

ICU patients

strokes - dysphagia

153
Q

how and where is the percutaneous jejunostomy tube

A

percutaneously placed directly into the proximal jejunum

154
Q

what are 3 main indications for placement of a percutaneous jejunostomy tube

A

major surgery to the upper digestive tract

pathology to the upper digestive tract that would contraindicate other forms of feeding tubes

to administer nutrition

301 MEDIMAGE (18 decks)

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