Lecture 5- Placement of Lines and Tubes Flashcards
Endotracheal Tube (ET Tube)
why are they used?
- assist ventilation
- isolate trachea to permit control of airway
- prevent gastric distension
- provide direct route for suctioning
- administer medications
Endotracheal Tube (ET Tube)
positioning
- wide bore tubes w/ radiopaque marker stripe & no side holes
- pt’s head in neutral position, the tip of ETT should be 3-5cm from carina
- diameter of ETT should be 1/3 to 1/2 width of trachea
- neck extension + flexion can change positioning
Endotracheal Tube (ET Tube)
complications with malposition
- too long: tip of ETT will slide into R bronchi
- too short: tip may damage vocal cord
- intubation could be into the esophagus not trachea
Tracheostomy Tubes
when to use?
- in pts w/ airway obstruction at or above level of larynx
- resp failure using long-term intubation (> 21d)
- airway obstruction during OSA
- paralysis of muscles that help w/ swallowing or respiration
Tracheostomy Tubes
positioning
- tip should be halfway between the stoma in which the tracheostomy tube was inserted and the carina
- not affected by extension and flexion
- size should be 2/3 of trachea
Tracheostomy Tubes
complications
- tracheal injury (pneumomediastinum, pneumothorax, subQ emphyema)
- cuff over inflation
- tracheal stenosis
Central Venous Catheters (CVC)
describe
- for venous access to instill chemo or hyperosmolar agents not suitable for peripheral venous admin
- measurement of central venous pressure
- to maintain and monitor intravascular blood volume
- venous access in pts w/ difficult access
Central Venous Catheters (CVC)
how to see on imaging? which veins commonly used?
- small & uniformly opaque w/out marker stripe
- placed in subclavian, internal jugular, or femoral veins
- subclavian & brachiocephalic veins join posterior to the medial ends of the clavicles
Central Venous Catheters (CVC)
placement
- should reach medial end of clavicle before descending, tip should be medial to the anterior end of 1st rib
- should descend lateral to the R side of spine and lie in the SVC
Central Venous Catheters (CVC)
complications
- often malpositioned w/ internal jugular lines (into right atrium or internal jugular)
- pneumothorax
- venous perforation
- placement of CVC into artery
Central Venous Catheters (CVC)
how would you know if you inserted into artery instead of vein?
4 components
- pulsatile
- bright red blood
- parallels aortic arch
- fails to descend to the right of the spine
Dialysis Catheters
types
- temporary: quinton catheter, good for 2-3 wks
- permanent: tunnels under skin
- red/blue ports: red= arterial port to draw blood from; blue = venous port to push blood back in
- large bore 13/14 French
Peripherally Inserted Central Catheter (PICC)
when to use?
- long term venous access (months)
- abx (most common use)
- frequent blood draws
Peripherally Inserted Central Catheter (PICC)
placement
placed into SVC (same as CVC)
Peripherally Inserted Central Catheter (PICC)
complications
- line may become clotted due to small diameter
- tip may become dislodged or in wrong position
Pulmonary Artery Catheter (Swan-Ganz catheter, PCWP catheter)
purpose
- monitor hemodynamic status of critically ill patients
- helps in differentiating cardiac vs noncardiac pulmonary edema
Pulmonary Artery Catheter: Swan-Ganz catheter, PCWP catheter
placement
- inserted into subclavian or internal jugular veins
- longer CVC
- tip is floated out into proximal R/L pulmonary artery (Swan-Ganz: no more than 2cm from hila)
- catheter’s balloon is temporarily inflated only when pressure measurements are made & then should be deflated
Pulmonary Artery Catheter: Swan-Ganz catheter, PCWP catheter
complications
- pulmonary infarction (occlusion or emboli)
- may produce a localized, confined perforation or pseudoaneurysm
- to reduce risk of complication make sure catheter tip is proximal not distal within pulmonary artery
Thoracotomy Tubes (Chest Tubes)
purpose
remove air/fluid from chest cavity
Thoracotomy Tubes (Chest Tubes)
positioning
- pneumothorax: anterosuperior
- effusion: posteroinferior
Thoracotomy Tubes (Chest Tubes)
how to help know where tube is positioned?
radiopaque stripe
Thoracotomy Tubes (Chest Tubes)
complications
- mispositioning can lead to inadequate drainage
- side hole of chest wall can lead to air leak (subq emphysema, inadequate drainage)
- injury to lung
- bleeding from neurovascular injury
- re-expansion pulmonary edema
Cardiac Pacemaker
uses
- cardiac conduction abnormalities
- certain conditions refractory to med treatment
Cardiac Pacemaker
placement
- all pacemakers have a pulse generator
- usually place in left anterior chest wall w/ leads entering subclavian vein
- two leads (tips in RA and RV) or three leads (RA, RV, coronary sinus)
- all leads should have gentle curves (no KINKS)
Cardiac Pacemaker
complications
- pneumothorax during placement
- fracture of leads
- perforation of heart
- leads may be in wrong position
- twiddler’s syndrome (pts twist leads under skin causing retraction)
Automatic Implantable Cardiac Defibrilator (ACID)
uses
help prevent sudden death (secondary to tachyarrhythmias)
Automatic Implantable Cardiac Defibrilator (ACID)
placement
- usually differentiated from pacemakers by wider and more opaque segment of 1+ electrodes
- one electrode usually placed in SVC or brachiocephalic vein and the other in the apex of the RV
Automatic Implantable Cardiac Defibrilator (ACID)
complications
- smooth curves of leads (no kinks)
- leads may fracture
- leads may migrate or become dislodged
Nasogastric Tubes
uses
- short term feedings
- meds
- decompression
Nasogastric Tubes
placement
- radiopaque stripe w/ side holes that disrupt it
- tip & all side holes should extend 10cm into stomach beyond esophagograstic (EG)
Nasogastric Tubes
complications
- coiling of NGT in esophagus (mispositioning)
- inserted into trachea, aspiration
- esophageal perforation
- long term use can cause reflux
- always get xray to confirm placement
Duodenal Feeding Tubes
uses
- dobbhoff or flexiflo
- for malnutrition, reduced risk aspiration, weighted tip
Duodenal Feeding Tubes
placement
post pyloric sphincter
Duodenal Feeding Tubes
complications
- coiling of NGT in the esophagus inserted into trachea
- esophageal perforation (never reinsert guidewire)
- always get xray to confirm placement
