Lines and Tubes Flashcards
1
Q
Why is it important for radiographers to have a good knowledge of lines and tubes?
A
For early detection of malpositioned lines.
2
Q
What is an Endotracheal Tube (ETT) used for?
A
Airway management
3
Q
What are the indications for use of an endotracheal tube?
A
- Inadequate arterial oxygenation, severe airway obstruction, shock and parenchymal diseases that impair gas exchange;
- upper airway obstruction;
- Impending gastric reflux or aspiration
- Provisions for tracheobronchial lavage and tracheal suctioning.
4
Q
What does Lavage mean?
A
Lavage: To wash out
5
Q
What is a tracheostomy?
A
A hole to make an artificial airway to create the same type of pathway
6
Q
T/F?
An ETT can be used when patients that have a tracheostomy.
A
True
7
Q
What approach is used to insert an ETT?
A
A translaryngeal approach via the mouth or nose is used.
8
Q
What is #1 pointing to?
A
The cuff of an ETT
9
Q
What are the possible damages of the cuff of an endotracheal tube?
A
- The cuff’s structure and pressure can damage the tracheal mucosa, (erosin of mucosa) especially during long term care.
- Cuff inflation can damage vocal folds and resulting in inadequate ventilation.
10
Q
What is another reason that a tracheostomy would be put in other than long term use?
A
If there is an obstruction above the larynx (i.e. tumours, traumatic injuries)
11
Q
T/F?
The cuff of an ETT is radiopaque.
A
False; not ussually visable in a radiograph unless it is over inflated.
12
Q
With a properly positioned ETT, where will the distal tip lie?
A
The distal tip will be 5 – 7 cm superior to the tracheal bifurcation (carina) when the neck is in neutral position.
13
Q
Is this ETT tube in the right place?
A
Yes
14
Q
What is the most common malposition of an ETT?
A
In the right main stem bronchus.
15
Q
Where should the proximal end of an ETT lie when the carina is not visible?
A
The tip of the ET tube should not lie higher than the level of medial ends of the clavicles.
16
Q
Where is the carnia?
A
Between T5-T7
17
Q
What is one of the risks assosiated with placing the ETT too high in the trachea?
A
- Inadvertent extubation
- Esophageal intubation: Air pumped into stomach resulting in regurgitation which then enters airway resulting on aspiration pneumonia.
18
Q
What are the complications associated with an ETT being too low, or being inserted into the right main stem bronchus?
A
- Bronchial intubation-Tube too low
- Atelectasis of the left lung
- Overventilation of the right and potential airway obstruction of the left.
19
Q
What is an atelectasis?
A
Atelectasis: Not properly inflating the lungs (could be due to pneumothorax too)
20
Q
Which side shows the alveoli being deflated?
A
The left side
21
Q
What can erosion of tracheal mucosa lead to?
A
Subcutaneous or mediastinal emphysema which is where Air goes outside of trachea into surrounding tissue (in the subcutaneous tissue)
22
Q
What pathology is shown here?
A
- Subcutaneous and mediastinal emphysema
- overdistention of the balloon cuff,
- distal extension of the balloon toward the endotracheal tube tip.
23
Q
What pathology is being shown here? What is the arrow pointing to?
A
-Subcutaneous/Mediastinal Emphysema
-Outpouching of air
24
Q
What can too high of positive pressure on mechanical ventialtion lead to?
A
PTX
25
What pathology is being shown here?
PTX
26
Who uses trachostomy tubes?
Required in patients who need long-term ventilation, tracheal suction or where oral or nasal tracheal intubation is not possible (facial trauma).
27
How is a tracheostomy tube inserted?
Through a tracheostomy
28
# T/F
Never remove tape or strap holding the tube in place.
True
29
Where should the tip of the tracheostomy tube lie?
The tip of TT should lay halfway between the stoma (hole) and the carina, (~ T2 - T3 vertebra).
30
# T/F?
Chin position does not affect the position of TT and its position is maintained with neck flexion and extension.
True
31
What is the middle line indicating?
The end of the trachostomy tube
32
What is another name for Thoracostomy Tubes?
Chest tubes
33
What are the different types of Thoracostomy Tubes?
Intrapleural tubes
Intracostal tubes
Drainage tubes
34
What is the purpose of Thoracostomy Tubes?
Removes fluid or air accumulated in either the intrapleural space, mediastinum or both.
| (Purpose of drainage)
35
What cases of negative pressure within the interpleural space can chest tubes drain fluid/air?
* pneumothorax (air),
* hemothorax (blood).
* pus (empyema/pyothorax),
* Serous fluid (hydrothorax)
* urine (urinothorax)
36
What pathology is being shown here?
Pleural effusion
37
What is a pleural effusion?
Accumulation of fluid within the lung
38
When does pleural fluid accumulation becomes radiographically evenident?
When enough fluid is present to show costophrenic blunting.
39
On a PA or AP chest projection, how much fluid needs to be present in order for it to become radiographically evident?
300ml
40
On a lateral chest projection, how much fluid needs to be present in order for it to become radiographically evident?
150 mL
41
# T/F?
Erect imaging (x-rays) may obscure visualization of pleural fluids and should be avoided when possible.
False; supine
42
For cases of pleural effusion, what is the direction of the insertion site for the thoracostomy tube?
In the anterior or mid-axillary line, directed posterior-inferiorly
43
For cases of pleural pneumothorax, what is the direction of the insertion site for the thoracostomy tube?
Directed antero-superiorly
44
What are the different holes in Thoracostomy Tubes?
Thoracostomy tubes have a terminal hole as well as side holes.
45
What is one very important thing to remeber when reading a radiograph with a patient that has chest tubes, regarding the holes in the tube?
No side holes should lie outside the chest or pleura and the tube should not float above the effusion.
46
What is the purpose of CXR done post tube placement?
| CXR: Chest imaging
1. Confirm placement/tube position
2. Assess therapeutic results
47
What pathology is shown here? What is the issue with the tubing?
-PTX noted on the left side with a partially collapsed lung
-One hole in tube is situated outside the rib cage, indicating malposition, likely resulting in insufficient suction.
48
Is this image taken pre or post tube insertion?
Pre tube insertion (radiographically appears on left side)
49
When is a PTX is visualized?
When the increased density of the collapsed lung is contrasted with a lateral radiolucency that is absent of lung markings.
50
What is easier to view a PTX; insipration or expiration? Why?
-Expiration is easier to view
-During inspiration, the lung expands laterally and meets the lateral rib edge, making small pneumothoraces harder to detect
51
Which of these images are taken on inspiration and expiration respectively?
A: Insipration
B: Expiration
52
What anchors the tube after a thoracostomy?
Sutures
53
What can partially dislodged tubes lead to?
Leaking at the insertion site and extracostal insertions may lead to subcutaneous emphysema.
54
What type of imaging is required when imaging patients with chest tubes?
Erect or semi-erect imaging whenever possible
55
# T/F?
Chest tubes need to be connected to suction and a drainage system
True
56
What are the 2 ways that suction chambers can be attached/placed?
1. Attached to continuous wall (external) suction to remove air/fluid
2. Placed with no active suction mechanism (gravity drainage).
57
What is a Central Venous Catheter (CVC)?
Catheter that is placed into a large vein (typically, above the heart).
58
What areas of the body can a CVC be inserted?
May be inserted through a vein in the neck, chest or arm, or femoral
**(central venous line or central line)**
59
How long can a CVC be left in?
Depending on catheter; from weeks to years
60
What is the function of double or triple lumen catheters?
Catheters that 2-3 tubes that lets patient receive more than 1 treatment at once.
61
Where is a CVC inserted in the neck?
In the internal jugular vein
62
Where is a CVC inserted in the chest?
Subclavian vein (most common site) or axillary vein
63
Where is a CVC inserted in the groin?
In the femoral vein
64
Where in the Superior Vena Cava is the tip of a CVC generally placed?
Tip positioned 2 – 3cm above the right atrial junction (for the majority of CVCs)
65
# T/F?
Infusions are less caustic in central veins than in smaller, peripheral veins.
True
66
# T/F?
The goal is to position the end (tip) of a CVC catheter in a small central vein.
False; large central vein
67
Where are long term Hickman, Groshong, Raaf, Perm Cath CVCs generally placed?
Usually inserted in the neck area
68
Where is a long term PICC CVC generally inserted?
Inserted into a vein in the arm towards the heart
69
Where is a Port-a-Cath CVC generally placed?
Usually underneath the skin on the chest, implanted inside
70
What brand of CVCs is used for the short term?
Swan Ganz
71
# T/F
The Internal jugular catheter CVC is intended to be for short term use?
True
72
What are the types of Percutaneous catheters?
Subclavian or IJ insertion catheters
73
What are the types of Externally Tunneled Catheters?
Hickman, Groshong catheters
74
What are the types of Totally implanted access ports in relation to CVCs?
Port-a-Cath, Mediport, Infusa Port
75
What are the purposes of CVCs?
1. measure central venous and cardiac pressures
2. administer drugs and fluids
draw blood
3. provide transfusions
4. provide TPN (Total Parenteral Nutrition)
5. provide dialysis
76
What are the Three common types of CVCs?
Tunneled central venous catheter, a peripherally inserted central catheter (PICC) and a subcutaneous (implanted) port.
77
# T/F?
Long term CVCs cause less infection and are more secure
True
78
What is a tunneled CVC?
A tunneled CVC is a tube that tunnels under the skin of the chest, enters a large vein near the collarbone and threads inside the vein to sit above the right atrium of the heart.
79
Where is the other end of the catheter on tunneled CVCs?
The other end of the catheter stays outside the body.
80
What are the benefits of Tunneled CVCs?
Long term; less infection; more secure
81
What is another name for a Dialysis Catheter?
Perm Cath/Raaf Cath
82
What is circled here?
Tip in SVC of a Dialysis Catheter
83
# T/F
Dialysis Catheters are tunneled under skin
True
84
What are 2 charecteristics of Dialysis Catheters
-Double lumen for dialysis
-One tip is shorter
85
How does blood circle through the dialysis catheter?
Blood is removed through the shorter tip and once processed through the dialysis unit, returned through the longer tip.
86
What are three unique charecteristics of the hickman catheter?
1. Double or triple lumen
2. Tunneled (long term), tip is uneven
3. Has clamps
87
Label 1 and 2. What catheter is this?
1. Attached clamps
2. Catheter
-This is a hickman catheter
88
What type of catheter is used for hemodialysis, apheresis, administration of I.V. fluids, blood products, drugs, chemotherapy and parenteral nutrition solutions, as well as blood withdrawal.
The hickman catheter
89
# T/F
The Groshong catheter is used short term.
False; used long term
90
Can Groshong catheters be used as pick lines?
Yes
91
How many lumens does the Groshong catheter have?
Double or triple lumen
92
# T/F
Groshong catheters have clamps
False; Has a valve at the tip, so does not have clamps
93
Label 1 and 2. What catheter is being shown here?
1. Tip
2. Three way Groshong valve
-Groshong catheter shown
94
What type of catheter is a powered hickman?
Tunneled venous catheter
95
What type of central line is shown?
-Hickman because we have the clamps
96
What are the 2 types of Non-tunneled CVCs?
1. Internal Jugular catheter
2. PICC
97
What type of catheter is an Internal Jugular catheter?
Short term venous catheter
98
What are the short term uses for the Internal Jugular Catheter?
Post-op, ICU
99
What is the function of Internal Jugular Catheters?
IV access to provide fluids and/or medications
100
What catheter is shown here?
Internal Jugular Catheter
101
What catheter is shown here?
Internal Jugular Catheter
102
If the Internal Jugular Catheter is improperly placed, where could the tube go?
Could go into the subclavian vein if improperly placed
103
How many lumens does a PICC line have?
Single, double or tripled lumen
104
Where does the PICC line start and end?
Vein in arm to distal SVC or cavoatrial junction
105
What are the consequences of using too high of a power rating in a PICC line?
Could cause an embolism
106
Can PICC lines be used for contrast injection?
Can be used for IV contrast media injection if power rated
107
What is the only type of PICC line that cannot be used for IV contrast injection?
GROSHONG
108
What catheter is being shown here?
PICC line in a baby
109
What is the result of not flushing a PICC line?
This could cause a stroke
110
How many lumens does a Pulmonary Arterial Line (Swan Ganz Catheter) have? Is it designed for short or long term use?
1. Single or multi-lumen.
2. Short term use
111
What type of catheter has a **tip that incorporates a small electrode used to monitor pulmonary artery pressures.**
Pulmonary Arterial Line (Swan Ganz Catheter)
112
What is the function of the Pulmonary Arterial Line (Swan Ganz Catheter)?
-Measures right sided heart and pulmonary pressure and output.
-This value is used to extrapolate left sided heart pressure.
113
What is the pathway that a Swan Ganz Catheter travels to get to the right pulmonary artery?
1. Internal Jugular V
2. Brachiocephalic V
3. SVC
4. Rt atrium
5. Rt ventricle
6. Pulmonary trunk
7. Rt Pulmonary artery
114
What is being shown here?
Swan Ganz Catheter
115
What is the issue with this Swan Ganz Catheter?
Improperly positioned; instead of it going into the right PA, it is going into the left pulmonary artery
116
What is being shown here?
Implanted Port
117
# T/F
An implanted port has a multi-lumen
True
118
What are the types of implated ports?
Port-a-Cath, Mediport, Infusa Port
119
Where does the catheter of implated ports terminate?
Terminates in the SVC or right atrium
120
What are the 2 main parts of an implated port?
Portal and catheter
121
What is the purpose of an implated port?
It is a port tunneled under the skin and may be used to administer medication, chemotherapy drugs and/or IV contrast media, and draw blood sample.
122
When this type of catheter is not accessed, it only needs an occasional flush but otherwise does not require care. What type of catheter is this?
Implanted port
123
What is being shown here?
An implanted port
124
What are the complications of CVCs?
1. Dislodgement
2. Occlusions
3. Infections
4. PTX and HTX
125
What is a NG tube?
It is a flexible plastic tube inserted through the nostrils, nasopharynx, and into the stomach or upper portion of the small intestine.
126
What are the 5 uses of NG tubes?
1. Short term enteral feeding
2. Administer Drugs
3. Decompression/Suctioning – prevent vomiting and aspiration
4. Lavage
5. GI imaging exams
127
What is the most common NG tube used for gastric decompression?
Levin tube
128
What are the differences between a suctioning tube and a feeding tube in thier radiographic appearances?
-Feeding tubes are narrower.
-Feeding tubes tend to have a radiopaque tip.
129
What tube is being shown here?
An NG tube
130
What does a Nasoenteric (NE) Tube pass through in the body?
Tube passes from nose, through stomach, and into small intestine
131
What are the uses of the Nasoenteric (NE) Tube?
1. Decompress bowel and relieves obstruction
2. Provide nutrition
3. Single or multilumen
132
How many chambers does a NE tube have?
3
133
What are the uses of each chamber of an NE tube?
1. #1 anchors it in the stomach
2. #2 for aspiration/suction
3. #3 for feeding
134
# T/F
A Gastrotomy is requried for placement of a Gastric/ Gastro-jejunal (GJ) Tube.
True
135
What is the purpose of GJ tubes?
GJ tube for long term feeds as the patient cannot or may not be allowed to ingest food by mouth
136
Where is the NG or NE tubes often taped to?
Often taped to the nose and safety-pinned to the chest
137
In what body position should a patient with an NG/NE tube used for decompression be in?
Semierect position
138
Where is a pacemaker placed in the body? Why?
Placed in the right atrium and/or right ventricle to regulate heart rhythm and speed by providing low-level electrical stimuli causing cardiac contraction.
139
What type of patient would use a permanent pacemaker?
Patients with arrhythmias
140
Where are temporary pacemakers located?
They are connected to pacing electrode inside the body, but the pacemaker is external to the patient’s body
141
What device is being shown here?
A pacemaker
142
What is the pathway that a pacemaker takes to the heart?
1. Subclavian
2. Right atrium
3. Right ventricle
143
What are the 2 main uses of an ICD?
1. Treat sudden cardiac arrests by delivering high energy shock.
2. Pace, using low energy
144
# T/F
An ICD is dual chambered; the tips are in both the right atrium and ventricle
True
145
What device is being shown here?
An ICD
146
**What 2 rules must an x-ray tech follow when positioning a patient with an ICD or a pacemaker?**
1. DO NOT abduct/elevate patient’s left arm (or side pacemaker is placed) for 24 hours post insertion.
2. Do not elevate elbow above shoulder height for lateral chest x-ray.
147
What is a lead?
A wire
148
# T/F
In is okay to remove external lines provided that the patient agrees.
False; DO NOT UNCLIP OR REMOVE
149
Where should an MRT move external lines when performing a chest x-ray?
They should move the external lines off to one side of the patient
150
What is being shown here?
ECG lines
151
This device is used to evaluate patient’s cardiac rhythm over certain amount of time using ECG electrodes placed on patient and connected to transmitter (also on patient). What device is this?
A holter monitor
152
Can you remove holter monitors?
Generally no, but if you do, it should be documented
153
What device is being shown here?
A holter monitor
154
Where do urinary drainage catheters enter?
The urethral meatus
155
What materials can urinary drainage catheters be made of?
Plastic, silicone or rubber
156
**What are the 2 types of urinary drainage catheters?**
1. Foley catheter
2. Straight catheter
157
**Any catheter that remains in place is called what?**
An indwelling catheter
158
This urinary drainage catheter does not have balloon and is for short term use. Which catheter is this?
A straight catheter
159
This urinary drainage catheter is long term, has a retention ballon that prevents the tube from escaping the bladder. Which catheter is this?
A Foley catheter
160
What type of urinary drainage catheter is an indwelling catheter?
A Foley catheter
161
What type of urinary drainage catheter is an intermiettent catheter?
A straight catheter
162
What is the orange catheter and the yellow catheter?
Orange: Straight catheter
Yellow: Foley catheter
163
# T/F
A urinary drainage bag must always be kept above the height of the bladder.
False; Keep the bag lower than the bladder.
164
What is a urinary drainage tube connected to?
Connected to external drainage bag.
165
What are the 5 Reasons for Catheterization of the urinary bladder?
1. Empty bladder
2. Irrigate the bladder or introduce drugs
3. Obtain specimen
4. Accurate measurement of urine output.
5. Imaging Procedures that require the introduction of contrast agents
166
What is one Imaging procedure that requires catheterization?
Cystogram/Voiding Cystourethrogram/CT Cystogram
167
Where is contrast administration preformed for a Cystogram?
Retrograde
168
What modality is used for Cystograms?
Fluoroscopy or sometimes CT
169
What bladder defect is being shown here?
Herneation
170
What bladder defect is being shown here?
Fistula
171
What bladder defect is being shown here?
Compression
172
What bladder defect is being shown here?
Divurticulum
173
What bladder defect is being shown here?
Rupture
174
What is being shown in this cystogram?
Contrast leaking out of the bladder
175
What pathology is being shown here?
Reflux of urine into the kidney (Congenital issue with the sphincter)
176
What is the most common cause of a stricture in the urinary bladder?
Benign Prostatic Hypertrophy (enlargement of prostrate gland)
177
What is the purpose of a Retrograde Urethrogram? What type of patient is it mostly performed on?
-To investigate the cause of poor urinary flow thought to be caused by a narrowing (stricture) of the **urethra.**
-Mostly performed on males
178
What is being shown here?
A Retrograde Urethrogram (normal)
179
What is being shown here?
Retrograde Urethrogram with stricture demonstrated
180
What are the reasons a patient could have a suprapubic catheter?
1. Post gynecological surgery
2. Urethral injuries
3. Prostatic enlargement and obstruction
| (when the urethra is comprimised)
181
What is a Condom catheter used for? How often must it be replaced?
-Incontinent male patients
-Must be replaced every 24 to 48 hours for infection control
182
Wherre are tissue drainage tubes placed?
Placed at or near wound or operative sites when drainage is required.
183
What are the different types of fluid drainage tubes?
1. Penrose Drain
2. Jackson-Pratt (JP) Drain
3. Hemovac
184
What drainage device is this?
A hemovac
185
Watch videos
1.https://youtu.be/xDv1D2c8eLY
2.https://youtu.be/72W5Z9agOPU
3.https://youtu.be/WTq_FZ7nn7A
186
What is being shown here?
A penrose drain
187
This drain lets blood and other fluids move out of the area of the surgery.
This keeps fluid from collecting under the incision and causing infection. What type of drain is this?
A penrose drain
188
This drain maintains constant, **low negative pressure** by means of a small bulb which is squeezed and slowly expands to create low pressure suction. What type of drain is this?
Jackson-Pratt (JP) Drain
189
This drain is very common with orthopedic surgeries and placed under the skin before closing. It also has negative pressure. What type of drain is this?
Hemovac
190
# T/F
Part of the Penrose drain will be inside the body
True
191
# T/F
The penrose drain is a rigid, hard plastic drain.
False; the penrose drain is a soft, flat, flexible tube
192
Where is the bulb of a JP drain connected to?
Bulb connected to end of tubing
193
What drain is being shown here?
JP drain
