Recognizing correct placement of lines and tubes: critical care rads Flashcards
Correct placement of ETT
Tip > 5 cm from carina (carina is usually at level of T4). Affected about 2 cm by flexion and extension of neck.
Correct placement of tracheostomy tube tip
1/2 way between stoma and carina (around T3). Not affected by flexion/extension of neck, unlike ETT.
Correct placement of central venous catheter
Tip in SVC
Correct placement of picc line
Tip in SVC
Correct placement of swan ganz catheter
Tip in proximal R or L pulmonary artery
Correct placement of pleural drainage tube
Anterior-superior for pneumothorax; posteroinferior for effusion
Correct placement of pacemaker
Tip at apex of RV; others in RA and/or coronary sinus
Correct placement of AICD
One lead in SVC and other in RV
Correct placement of NG tube
Tip in stomach
5 indictations for ETT
Assist ventilation Isolate trachea to permit control of airway Prevent gastric distention Provide direct route for suctioning Administer meds
Most common malposition of ETT
Because of the shallower angle and wider diameter, into the right main bronchus leading to atelectasis or right sided tension pneumo.
4 indications for tracheostomy
Patients with airway obstruction nat or above level of larynx In resp failure requiring long term intubation >21 days Airway obstruction during sleep apnea Paralysis of muscles affects swallowing or respiration
Immediately after placing tracheostomy, look for signs of “whoops”, such as … ?
Signs that you perforated the trachea, like pneumomediastinum, pneumothorax, or subQ emphysema.
Most common long-term complication of tracheostomies and most common location of this
Tracheal stenosis, which can occur at the entrance stoma, level of the cuff, or at the tip of tube, but is most common at the stoma.
3 indications for central venous catheters
Venous access not suitable for peripherall venous administration (e.g., chemo) Measurement of CVP Maintain and monitor intravascular blood volume
Most common malposition of central venous catheter
Often tips land in right atrium or internal jugular vein if inserted via subclavian vein. If in the RA, they could produce cardiac arrhythmia!!
Next step after initial placement of CVC fails
Obtain a chest radiograph before trying insertion of the other side to avoid possibility of producing B/L pneumothoraces.
Indications for PICC lines
Long term venous access (months) Administer rx such as chemo, abs Frequent blood sampling Because of small size, could be inserted into antecubital vein.
2 reasons swan ganz catheters are used
Monitor hemodynamic status of critically ill patients Help in differentiating cardiac from non-cardiac pulmonary edema
Most common significant complication of swan ganz catheter
Pulmonary infarction from occlusion of pulmonary artery by catheter or from emboli arising from catheter.
Most commonly, malpositioning of chest tubes lead to what ?
Inadequate drainage, rather than serious complications. This includes times when its inadvertently placed in the major fissure.
What type of device is this?
What type of device is this?
What happened here? (Black arrow)
NG tube (aka Dobbhoff tube) entered the trachea instead of the esophagus and its tip extends to the right lower lobe bronchus. Always get a CXR to confirm placement before you start feeding the pt through this tube for this reason! NG tubes are the most COMMONLY MALPOSITIONED of all tubes and lines. Ideally, it should be post-pyloric, in the duodenum or jejunum.
