Lecture 1a: Tubes & Lines

Question 1

what does an endotracheal tube do

Answer 1

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

Question 2

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

Answer 2

seals trachea for positive pressure ventilation and prevents aspiration

Question 3

endotracheal tubes are inserted past where

Answer 3

past vocal chords

Question 4

where does the carina lie

Answer 4

between T5-7

Question 5

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

Answer 5

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

Question 6

what is the correct position for endotracheal tubes tips

Answer 6

min 2cm, max 4cm from carina

ideal position is 3cm above carina

Question 7

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

Answer 7

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

Question 8

what happens if the ETT is placed too high

Answer 8

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

Question 9

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

Answer 9

right as its more vertical than the left

Question 10

what could malpositioned ETT do to the lung lobe

Answer 10

lung lobe could collapse

Question 11

how is the tracheostomy tube different from a ETT

Answer 11

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

Question 12

where is tracheostomy tube located

Answer 12

between the 2nd and 3rd tracheal rings

Question 13

where does the tracheostomy tube tip lie beteween

Answer 13

midway or 2/3 between stoma and carina

Question 14

non tunnelled Central venous catheter lines cannulate where

Answer 14

the jugular vein in the neck straight down to SVC

Question 15

tunnelled Central venous catheter lines cannulate where

Answer 15

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

Question 16

what is the common access site for CVL

Answer 16

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

Question 17

in what situation do you want lines in the right atrium

Answer 17

only for vascular catheter

Question 18

what is the correct placement of right CVL

Answer 18

in lower SVC before the right atrium

at the level carina

Question 19

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

Answer 19

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)

Question 20

what is the correct placement of left CVL

Answer 20

can have tip below the level of the carina

Question 21

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

Answer 21

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

Question 22

what is cannulated for tunneled CVC

Answer 22

subclavian vein

Question 23

where does the Swan Ganz catheter normally lie

Answer 23

in the right atrium

Question 24

what is the path of a Swan Ganz catheter

Answer 24

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

Question 25

where should the tip of the Swan Ganz catheter be

Answer 25

no further than the left/right main bronchus

or within 2cm of hilar region

Question 26

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

Answer 26

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

Question 27

what are the 3 components of a correctly placed PA catheter

Answer 27

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

Question 28

the tip of the chest drain should lie where

Answer 28

above diaphragm inside the rib cage and superimposed over the lung

Question 29

where should the side holes of the chest drain be inside

Answer 29

insider pleural cavity

Question 30

are foley type mediastinal drains seen on CXR, why?

Answer 30

no as they are less radiopaque and have no opaque marker

Question 31

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

Answer 31

inserted percutaneously into the descending aorta via the femoral artery

Question 32

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

Answer 32

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

Question 33

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

Answer 33

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

Question 34

how and where is the percutaneous jejunostomy tube

Answer 34

percutaneously placed directly into the proximal jejunum