Chest - Lines Flashcards
What does CVC stand for?
and what is it typically used for?
What side is it best placed?
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
Insertion, Destination, Malpostion and complications for a CVC
▪ 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
Other than pneumoThorax , wha tother complications can arise from CVC malposition ?
If it goes too far into right ventricle then can cause arrhythmia of heart.
Worst form of malposition of CVC?
Travelled into jug. vein causing a retrograde flow of blood + med into the brains vasculature.
What does PICC stand for?
Peripherally Inserted Central Catheter
What are PICC used for?
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.
PICC insertion and destination
Inserted into arm veins below cubital fossa. and pushed towards heart towards SVC
What can be a challenge for a PICC ?
Difficult to see on CXR, especially in larger patients
and again can flow retrograde in jug. Vv.
What are permacaths used for?
dialysis and chemo
What are the two most common manufactured permacaths?
Hickman and Groshong
Insertion, destination and infection rates for permacath
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.
Haemoptysis meaning
Coughing up blood
Why can imaging a permacath be difficult?
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
What is a portacath and what is its insertion and destination
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.
Problems when imaging portacath on CXR?
Cant see drum but lead will be visible.
What Heart condition is pacemakers traditionally used for ?
brachycardia
2 types of pacemakers
uni polar: apex of right ventricle
Bipolar: Right atrial appendage and right ventricular apex
Where are pacemakers inserted from
typically placed on non-dominant side and directed through SVC into hear chambers
Projections for pacemaker?
PA/AP and lat.
lateral is needed to assess placement in anteropostero plane.
Where do you not want Endotracheal tube to go?
oesophagus
What does ETT stand for?
what is its purpose and what is its destination?
Endotracheal tube is for patients that require mechanical ventilation of the respiratory tract.
It should be placed 5CM ABOVE THE CARINA
Patient positioning for ETT
Head neutral or slightly extended to show correct position
Bad positioning of ETT
Too far up trachea.
in oeshpagus / stomach
pushed too far into bronchus (typically right)
why is the ETT being pushed too far into a bronchus bad?
Will only supply o2 to the lobe it is in, meaning other lobe and lung will be starved of oxygen.
What is a NG tube?
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.
Good NG tube placement?
Runs down oesophagus, into stomach and curves back up in atrium of stomach
What does ICC standfor?
and what is it used for?
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.
ICC insertion and destination
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.
What is perfect placement of ICC
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.
What can a improper ICC placement cause?
Subcutaneous emphysema
IF an ICC is angled upwards (to top of chest) what position should the patient be in?
Seated upright
2 things to ensure good patient safety around a ICC and chest drain
Hand hygiene as it’s an open wound and infection risk.
Never pick it up above the level of line or backflow will occur.
