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Patient Management > Lines and Tubes > Flashcards

Lines and Tubes Flashcards

1
Q

Radiographers Role in lines and tubes

A

Early detection of malpositioned lines
- can alert the appropriate person

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2
Q

What are endotracheal tubes for (ETT)

A

Airway management

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3
Q

Indications for Endotracheal tubes

A

need for mechanical ventilation due to inadequate arterial oxygenation, severe airway obstruction, shock and parenchymal diseases that impair gas exchange;

upper airway obstruction;

impending gastric reflux or aspiration; and

provisions for tracheobronchial lavage and tracheal suctioning

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4
Q

Endotracheal Tube Cuff

A

Cuff us used to hold ETT tube in place and compatible for long term use

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5
Q

How is ETT placement confirmed

A
  • chest xray
  • shows distal tip 5-7cm superior to the tracheal bifurcation
  • shouldnt be higher than the medial ends of the clavicle (inadvertent extubation)
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6
Q

Most Common ETT misplacement

A
  • intubation of the right stem bronch
  • can cause over ventiliation of right lung & airway obstruction of the left
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7
Q

Complications associated with Endotracheal Intubation when its too low

A

Too low
- bronchial intubation
- causes atelectasis on the left lung when its in the right bronchus
- Not when too low but positive pressure can result in pnuemothorax

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8
Q

Complications associated with Endotracheal Intubation when its too high

A
  • esophageal intubation (regurgitation and aspiration pneumonia)
  • cuff inflation can damage vocal cords
  • greater chance of extubation
  • erosion of tracheal mucosa from cuff trauma causing emphysema
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9
Q

Subcutaneous/Mediastinal Emphysema secondary to intubation on imaging

A
  • revealed by chest radiograph
    -overdistention of the balloon cuff
  • CT can reveal as well
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10
Q

Tracheostomy Tube (TT)

A
  • patients who need long term ventilation
  • tracheal suction
  • facial trauma
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11
Q

Tracheostomy Tube Position

A

The tip of TT should lay halfway between the stoma and the carina, (~ T2 - T3 vertebra).
- chin position does not affect postion of TT (doesnt move with neck extenstion and flexion)

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12
Q

Thoracostomy Tube other names

A
  • Chest tubes
  • Intrapleural tube
  • intercostal tube
  • drainage tubes
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13
Q

Thoracostomy Tubes purspose

A
  • used for drainage
  • removal of air fluids in intrapleural space or mediastinum
  • reestablish negative air pressure
  • pneumo/hemo
  • pus (emphysema)
  • serous fluid
  • urine
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14
Q

Radiographic appearance of Effusion

A
  • pleural fluid superimposing over costophrenic blunting
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15
Q

Holes on thoracostomy tubes

A

side holes should never be outside of the plueral space
tube should not float above the effusion

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16
Q

need for imaging post tube placement

A

Chest xray to confirm tube placement
assess therapuetic results

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17
Q

Central Venous Catheter

A

Catheter placed into large vein above heart
- central line
- internal jugular vein
- subclavian vein
- femoral vein

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18
Q

Long term CVCs

A
  • tunneled under the skin
  • Hickman, Groshong, Raaf, Perm Cath
    PICC
    Port-a-Cath
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19
Q

Short term CVCs

A
  • internal jugular catheter
  • swan ganz
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20
Q

CVC uses

A

measure central venous and cardiac pressures
administer drugs and fluids
draw blood
provide transfusions
provide TPN (Total Parenteral Nutrition)
provide dialysis

21
Q

Tunneled CVC

A

under the skin of the chest entering large vein near collarbone to sit above right atrium of the heart
- used for long term, less infection and more secure

22
Q

Dialysis Catheter

A
  • perm cath/raaf cath
  • tunneled under the skin tip in SVC
  • double lumen for dialysis
  • blood removed from one tip and returned through the longer one
23
Q

Hickman catheter design

A

double/triple lumen
tunneled/long term
has clamps

24
Q

hickman catheter uses

A
  • used for hemodialysis, IV fluids, chemo, blood therapy
25
Groshong catheter design
- Double or triple lumen - Long term IV access – not typically used for dialysis - Tunneled, but tip is even - Has a valve at the tip, so does not have clamps
26
Nontunneled CVCs
- internal jugular catheter - PICC
27
Internal Jugular Catheter uses
provide fluids and medications - post op/ICU
28
PICC design and uses
Single, double or tripled lumen Vein in arm to distal SVC or cavoatrial junction A Groshong catheter may also be used as a PICC - can be used for contrast media injection if power rated (NOT groshong)
29
PICC radiograph appearance
- goes up arm and enters near SVC
30
Pulmonary Arterial Line (Swan Ganz Catheter)
- single or multi lumen - tip has small electrode used to monitor pulmonary artery pressure - measures right sided heart and pulmonary pressure - valve used to extrapolate left sided heart pressure
31
Swan Ganz Catheter Pathway
Internal Jugular V > Brachiocephalic V > SVC > Rt atrium > Rt ventricle > Pulmonary trunk > Rt Pulmonary artery
32
Swan Ganz Radiographic Appearance in Left PA
33
Implanted Ports
- surgically placed under the skin - long term uses - consists of portal and catheter - catheter terminates SVC and right atrium - common for oncology patients - Port-a-cath
34
Nasogastric Tubes placement and uses
- flexible plastic tubes down the nasopharynx to stomach or small intestine - should be confirmed with x-ray Short term enteral feeding Administer Drugs Decompression/Suctioning – prevent vomiting and aspiration
35
Suctioning vs Feeding NG tubes
Feeding tubes are narrower. Feeding tubes tend to have a radiopaque component, usually at the tip. Suctioning: Most common NG tube used for gastric decompression is the Levin tube. Small caliber to allow trans nasal passage Single lumen with several holes at the tip
36
Nasoenteric Tube
Tube passes from nose, through stomach, and into small intestine Decompress bowel and relieves obstruction Provide nutrition Single or multilumen
37
Moss esophageal tube
- 3 chambers - 1 anchors in the stomach - 1 for aspiration and suctioning - 1 for feeding
38
GJ tube
- used for long term feeding - food needs to bypass stomach
39
Pacemakers
Electromechanical devices inserted under the patient’s skin and leads (wires) that are placed in the right atrium and/or right ventricle to regulate heart rhythm and speed. Device provides low-level electrical stimuli causing cardiac contraction.
40
Who is most likely to have a pacemaker
- patients with arrhythmias
41
Internal Cardioverter Defribrillator
- desgined to treat sudden cardiac arrest - may also pace using low energy - inserted under fluoroscopic guidance - dual tips in right atrium and ventricle
42
Working with patients with ICDs and pacemakers
DO NOT abduct/elevate patient’s left arm (or side pacemaker is placed) for 24 hours post insertion. Do not elevate elbow above shoulder height for lateral chest x-ray.
43
External Lines (ECG or cardiac monitors)
DO NOT UNCLIP OR REMOVE! Manipulate with care, to not dislodge. Lines will show but can move into better location. Wires will swivel around electrode to allow MRT to move them out of the way.
44
Holter monitors
Device used to evaluate patient’s cardiac rhythm over certain amount of time. ECG electrodes placed on patient and connected to transmitter (also on patient).
45
Urinary Drainage Catheters
Urinary catheterization is the insertion of a tube (plastic, silicone or rubber) via the urethral meatus into the bladder using aseptic technique. 2 types - foley catheter (indwelling) - straight catheter
46
Penrose Drain
It lets blood and other fluids move out of the area of your surgery. This keeps fluid from collecting under your incision and causing infection. Part of your Penrose drain will be inside your body.
47
JP (jackson Pratt) Drain
Maintain constant, low negative pressure by means of a small bulb which is squeezed and slowly expands to create low pressure suction.
48
Hemovac
Very common with orthopedic surgeries Drain placed under the skin before closing

Patient Management (7 decks)

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