tubes and lines radiology

icu tubes and lines

endotracheal tube should be ~T4-T5 on portable chest xray for good position

flexion/extension can move the ETT as much as 2cm

complications of ET tubes

dislodgment

vocal cord injury

mainstem bronchus

put in esophagus

laceration

tracheostenosis/malacia

tracheostomy tube put in level of 3rd tracheal cartilage, not effected by motion of head

complications

emphysema, pneumomediastinum, pneumothorax

get xray after putting them in

central venous catheter

usually from IJ, tip should be in SVC, not atrium b/c can cause arrhythmias

malposition

air embolism

pneumothorax/hemothorax

cardiac perf

sepsis

venous perf

picc

small caliber

can left for long duration

preferred to end in svc

do NOT ever attempt power injecting into these lines

malposition

ectopic infusion into mediastinum or pleural space

catheter breaking/embolism

puncture blood vessel

clot

air embolization

chest tube

should always run medial to inner margins of ribs

chest tube

posteoinferior for effusion

anterosuperior for pneumothorax

complications

bleeding/laceration, rapid expansion leads to flash pulmonary edema

bp fistula

ng tubes

at least 10 cm should be in stomach

risk malposition, perf the esophagus, over time indwelling tubes reflux

intra-aortic balloon pump

inflate during diastole - increase return to coronary arteries,

pulmonary artery catherter aka swan ganz

dx cariac and non cardiac pulmonary edema

should be in pulmonary artery WITHIN THE MEDIASTINAL SHADOW

can cause pulmonary infarction (balloon inflated for long time)

embolization (tip breaks off)

perf the artery