Chest - Lines

Question 1

What does CVC stand for?

and what is it typically used for?

What side is it best placed?

Answer 1

Central Venous Catheter

Long term medication can be damaging to periphery vasculature so CVC gets meds to central vasc and also makes the medicine more efficient.

Right side placement

Question 2

Insertion, Destination, Malpostion and complications for a CVC

Answer 2

▪ Insertion: The internal jugular vein or subclavian vein are most common sites of venous access for insertion. The right side is favoured as it provides a more direct route

▪ Destination: Optimal position is in the lower third of the Superior Vena Cava (SVC), but anywhere between the brachiocephalic veins and the right atrium is deemed acceptable

▪ Malposition can occur in smaller vessels or within the right atrium or right ventricle of the heart (which can cause arrhythmias)

▪ A complication of CVC insertion is a pneumothorax. This should always be checked for on the post-insertion CXR

Question 3

Other than pneumoThorax , wha tother complications can arise from CVC malposition ?

Answer 3

If it goes too far into right ventricle then can cause arrhythmia of heart.

Question 4

Worst form of malposition of CVC?

Answer 4

Travelled into jug. vein causing a retrograde flow of blood + med into the brains vasculature.

Question 5

What does PICC stand for?

Answer 5

Peripherally Inserted Central Catheter

Question 6

What are PICC used for?

Answer 6

Short term version of CVC. and lower infection rate than CVC

typically for radiation therepy, antibiotics etc.

low maintenence so they can be taken outside of hospital.

Question 7

PICC insertion and destination

Answer 7

Inserted into arm veins below cubital fossa. and pushed towards heart towards SVC

Question 8

What can be a challenge for a PICC ?

Answer 8

Difficult to see on CXR, especially in larger patients

and again can flow retrograde in jug. Vv.

Question 9

What are permacaths used for?

Answer 9

dialysis and chemo

Question 10

What are the two most common manufactured permacaths?

Answer 10

Hickman and Groshong

Question 11

Insertion, destination and infection rates for permacath

Answer 11

Insertion: A Permacath involves a tunnel being created just under the skin from below the clavicle to the site of the needle insertion into the IJV or Sub clavian V.

▪ Destination: The catheter is passed through the tunnel and threaded onto a guide wire that is inserted into the vein and down to the SVC.

▪ Permacaths provide a distance between the entry site into the vein and the exit site from the skin. This allows a low infection rate and means that these catheters can remain in place for up to 12 months.

Question 12

Haemoptysis meaning

Answer 12

Coughing up blood

Question 13

Why can imaging a permacath be difficult?

Answer 13

Due to variable insertion sites it can be hard to see where it has been inserted, meaning seeing which blood vessel it as entered is difficult

Question 14

What is a portacath and what is its insertion and destination

Answer 14

Allows a constant puncture site for catheters. Used for chemo but also patients who need frequent medication e.g. cystic fibrosis. It has a low infection rate and is slightly less invasive so better for children.

▪ Insertion: The portal is inserted under the skin in the upper chest and the catheter is then tunneled into the internal jugular or subclavian vein.

▪ Destination: The permacath is directed into the SVC.

Question 15

Problems when imaging portacath on CXR?

Answer 15

Cant see drum but lead will be visible.

Question 16

What Heart condition is pacemakers traditionally used for ?

Answer 16

brachycardia

Question 17

2 types of pacemakers

Answer 17

uni polar: apex of right ventricle

Bipolar: Right atrial appendage and right ventricular apex

Question 18

Where are pacemakers inserted from

Answer 18

typically placed on non-dominant side and directed through SVC into hear chambers

Question 19

Projections for pacemaker?

Answer 19

PA/AP and lat.

lateral is needed to assess placement in anteropostero plane.

Question 20

Where do you not want Endotracheal tube to go?

Answer 20

oesophagus

Question 21

What does ETT stand for?

what is its purpose and what is its destination?

Answer 21

Endotracheal tube is for patients that require mechanical ventilation of the respiratory tract.

It should be placed 5CM ABOVE THE CARINA

Question 22

Patient positioning for ETT

Answer 22

Head neutral or slightly extended to show correct position

Question 23

Bad positioning of ETT

Answer 23

Too far up trachea.

in oeshpagus / stomach

pushed too far into bronchus (typically right)

Question 24

why is the ETT being pushed too far into a bronchus bad?

Answer 24

Will only supply o2 to the lobe it is in, meaning other lobe and lung will be starved of oxygen.

Question 25

What is a NG tube?

Answer 25

nasogastric tube (can sometimes be just oral)

It can be used for administering meds, evaluation of upper GI bleeds, Nourishment, Gastric decompression and relief of small bowel obstruction, aspiration of gastric fluid.

Question 26

Good NG tube placement?

Answer 26

Runs down oesophagus, into stomach and curves back up in atrium of stomach

Question 27

What does ICC standfor?

and what is it used for?

Answer 27

Inter Costal Catheter

Pneumo/ haemo thorax or pleural effusion. and is used to drain gas or fluid from that space. creating negative lung intra-thoracic pressure and allowing lungs to reflate.

Question 28

ICC insertion and destination

Answer 28

Insertion: Most commonly there are inserted in the 4th or 5th intercostal space, just anterior to the mid-axillary line.

▪ Destination: Pleural space, in contact with the material to be drained.

Question 29

What is perfect placement of ICC

Answer 29

It NEEDS TO BE IN PLEURAL SPACE and in-contact with the collection it wants to drain otherwise conditions such as pneumo or hydrothorax will persist.

Question 30

What can a improper ICC placement cause?

Answer 30

Subcutaneous emphysema

Question 31

IF an ICC is angled upwards (to top of chest) what position should the patient be in?

Answer 31

Seated upright

Question 32

2 things to ensure good patient safety around a ICC and chest drain

Answer 32

Hand hygiene as it’s an open wound and infection risk.

Never pick it up above the level of line or backflow will occur.