Lines and Tubes Flashcards
Why is it important for radiographers to have a good knowledge of lines and tubes?
For early detection of malpositioned lines.
What is an Endotracheal Tube (ETT) used for?
Airway management
What are the indications for use of an endotracheal tube?
- 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.
What does Lavage mean?
Lavage: To wash out
What is a tracheostomy?
A hole to make an artificial airway to create the same type of pathway
T/F?
An ETT can be used when patients that have a tracheostomy.
True
What approach is used to insert an ETT?
A translaryngeal approach via the mouth or nose is used.
What is #1 pointing to?
The cuff of an ETT
What are the possible damages of the cuff of an endotracheal tube?
- 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.
What is another reason that a tracheostomy would be put in other than long term use?
If there is an obstruction above the larynx (i.e. tumours, traumatic injuries)
T/F?
The cuff of an ETT is radiopaque.
False; not ussually visable in a radiograph unless it is over inflated.
With a properly positioned ETT, where will the distal tip lie?
The distal tip will be 5 – 7 cm superior to the tracheal bifurcation (carina) when the neck is in neutral position.
Is this ETT tube in the right place?
Yes
What is the most common malposition of an ETT?
In the right main stem bronchus.
Where should the proximal end of an ETT lie when the carina is not visible?
The tip of the ET tube should not lie higher than the level of medial ends of the clavicles.
Where is the carnia?
Between T5-T7
What is one of the risks assosiated with placing the ETT too high in the trachea?
- Inadvertent extubation
- Esophageal intubation: Air pumped into stomach resulting in regurgitation which then enters airway resulting on aspiration pneumonia.
What are the complications associated with an ETT being too low, or being inserted into the right main stem bronchus?
- Bronchial intubation-Tube too low
- Atelectasis of the left lung
- Overventilation of the right and potential airway obstruction of the left.
What is an atelectasis?
Atelectasis: Not properly inflating the lungs (could be due to pneumothorax too)
Which side shows the alveoli being deflated?
The left side
What can erosion of tracheal mucosa lead to?
Subcutaneous or mediastinal emphysema which is where Air goes outside of trachea into surrounding tissue (in the subcutaneous tissue)
What pathology is shown here?
- Subcutaneous and mediastinal emphysema
- overdistention of the balloon cuff,
- distal extension of the balloon toward the endotracheal tube tip.
What pathology is being shown here? What is the arrow pointing to?
-Subcutaneous/Mediastinal Emphysema
-Outpouching of air
What can too high of positive pressure on mechanical ventialtion lead to?
PTX
What pathology is being shown here?
PTX
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).
How is a tracheostomy tube inserted?
Through a tracheostomy
T/F
Never remove tape or strap holding the tube in place.
True
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).
T/F?
Chin position does not affect the position of TT and its position is maintained with neck flexion and extension.
True
What is the middle line indicating?
The end of the trachostomy tube
What is another name for Thoracostomy Tubes?
Chest tubes
What are the different types of Thoracostomy Tubes?
Intrapleural tubes
Intracostal tubes
Drainage tubes
What is the purpose of Thoracostomy Tubes?
Removes fluid or air accumulated in either the intrapleural space, mediastinum or both.
(Purpose of drainage)
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)
What pathology is being shown here?
Pleural effusion
What is a pleural effusion?
Accumulation of fluid within the lung
When does pleural fluid accumulation becomes radiographically evenident?
When enough fluid is present to show costophrenic blunting.
On a PA or AP chest projection, how much fluid needs to be present in order for it to become radiographically evident?
300ml
On a lateral chest projection, how much fluid needs to be present in order for it to become radiographically evident?
150 mL
T/F?
Erect imaging (x-rays) may obscure visualization of pleural fluids and should be avoided when possible.
False; supine
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
For cases of pleural pneumothorax, what is the direction of the insertion site for the thoracostomy tube?
Directed antero-superiorly
What are the different holes in Thoracostomy Tubes?
Thoracostomy tubes have a terminal hole as well as side holes.
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.
What is the purpose of CXR done post tube placement?
CXR: Chest imaging
- Confirm placement/tube position
- Assess therapeutic results
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.
Is this image taken pre or post tube insertion?
Pre tube insertion (radiographically appears on left side)
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.
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
Which of these images are taken on inspiration and expiration respectively?
A: Insipration
B: Expiration
What anchors the tube after a thoracostomy?
Sutures
What can partially dislodged tubes lead to?
Leaking at the insertion site and extracostal insertions may lead to subcutaneous emphysema.
What type of imaging is required when imaging patients with chest tubes?
Erect or semi-erect imaging whenever possible
T/F?
Chest tubes need to be connected to suction and a drainage system
True
What are the 2 ways that suction chambers can be attached/placed?
- Attached to continuous wall (external) suction to remove air/fluid
- Placed with no active suction mechanism (gravity drainage).
What is a Central Venous Catheter (CVC)?
Catheter that is placed into a large vein (typically, above the heart).
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)
How long can a CVC be left in?
Depending on catheter; from weeks to years
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.
Where is a CVC inserted in the neck?
In the internal jugular vein
Where is a CVC inserted in the chest?
Subclavian vein (most common site) or axillary vein
Where is a CVC inserted in the groin?
In the femoral vein
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)
T/F?
Infusions are less caustic in central veins than in smaller, peripheral veins.
True
T/F?
The goal is to position the end (tip) of a CVC catheter in a small central vein.
False; large central vein
Where are long term Hickman, Groshong, Raaf, Perm Cath CVCs generally placed?
Usually inserted in the neck area
Where is a long term PICC CVC generally inserted?
Inserted into a vein in the arm towards the heart
Where is a Port-a-Cath CVC generally placed?
Usually underneath the skin on the chest, implanted inside
What brand of CVCs is used for the short term?
Swan Ganz
T/F
The Internal jugular catheter CVC is intended to be for short term use?
True
What are the types of Percutaneous catheters?
Subclavian or IJ insertion catheters
What are the types of Externally Tunneled Catheters?
Hickman, Groshong catheters
What are the types of Totally implanted access ports in relation to CVCs?
Port-a-Cath, Mediport, Infusa Port
What are the purposes of CVCs?
- measure central venous and cardiac pressures
- administer drugs and fluids
draw blood - provide transfusions
- provide TPN (Total Parenteral Nutrition)
- provide dialysis
What are the Three common types of CVCs?
Tunneled central venous catheter, a peripherally inserted central catheter (PICC) and a subcutaneous (implanted) port.
T/F?
Long term CVCs cause less infection and are more secure
True