LINES AND TUBES IN CHEST RADIOGRAPH.pptx

CHEST XRAY FINDINGS OF LINES AND TUBES

1. LINES & TUBES -BY DR.ANJANA

2. CONTENTS Central Venous Catheters Swan-Ganz Catheters Intra-Aortic Balloon Pumps Endotracheal Tubes Tracheostomy Tubes Chest Tubes   Nasograstric Tubes Umbilical catheter

3. Access: via internal jugular / femoral / subclavian vein Position:tip at SVC or cavo -atrial junction used to monitor central venous pressure in the ICU and also allow for intravenous fluid or medication administration.

4. COMPLICATIONS MALPOSITION PNEUMOTHORAX BREAKAGE &EMBOLISATION CLOT FORMATION PINCH OFF SYNDROME- BETWEEN 1 ST RIB AND CLAVICLE; a complication of  subclavian venous catheterization .

5. The tip is in Descending Thoracic Aorta. When the line extends above the clavicle, it is very likely that it lies in the subclavian artery. The subclavian vein normally lies behind the clavicle .

6. AIR EMBOLISM IN MAIN PULMONARY ARTREY

7. PNEUMOTHORAX

8. RIGHT PARATRACHEAL SOFTTISSUE WITH BULGING CONTOURS[MEDIASTINAL HEMATOMA]

9. TIP PLACED IN LEFT PULMONARY ARTREY /PROXIMAL INTERLOBAR ARTREY ACCESS-SUBCLAVIAN/JUGULAR /FEMORAL VEIN BALLOON TIPPED PULMONARY ARTREY CATHETER –TO MEASURE CAPILLARY WEDGE PRESSSURE 2 ND CHANNEL- ASSESS CENTRAL VENOUS PRESSURE & CARDIAC OUTPUT

10. TIP IN LEFT PULMONARY ARTREY:SHOULDNOT BE >1CM LATERAL TO MEDIASTINAL MARGIN;SHOULDN’T EXTEND BEYOND PULMONARY HILUM

11. COMPLICATIONS PULMONARY INFARCTION-DISTAL DISPLACEMENT OF CATHETER ARRHYTHMIA-TIP IN RIGHT ATRIUM PULMONARY ARTREY RUPTRE INTRACARDIACKNOTTING

12. INTRACARDIAC KNOTTING

13. MALPOSITION:IN IVC

14. COMPLICATION:INFLATED BALLOON ;SHOULDBE INFLATED ONLY WHEN MEASUREMENTS ARE TAKEN

15. INSERTED VIA FEMORAL ARTREY RETROGRADE TO THORACIC AORTA TIP SHOULD BE JUST DISTAL TO SUBCLAVIAN ARTREY SEEN AS A LONG RADIOLUCENT TUBE WITH METALLIC TIP

16. COMPLICATIONS BALLOON ADVANCED TOO FAR-OBSTRUCTION OF LEFT SUBCLAVIAN ARTREY/ EMBOLUS BALLON NOT ADVANCED – INADEQUATE PULSATION DURING DIASTOLE EMBOLI RUPTRE

17. PLACED IDEALLY AT T4 LEVEL 4 CM ABOVE CARINA 3 to 4 cm below the vocal cords in adults. The ETT moves with the chin: With extension the tip recedes cephalad up to 2 cm; with flexion, the tip advances caudad up to 2 cm. In children, the trachea is shorter, and the optimum position for the tip of the ETT is 1.5 cm above the carina..

18. COMPLICATIONS Insertion into the esophagus . On CXR, the ETT will be situated just lateral to the trachea.the stomach becomes markedly distended, BUT NO ASPIRATION Pharyngeal placement - distend the stomach with air, with ASPIRATION of gastric contents. tracheal laceration with an overinflated cuff herniating through the tear on CXR. A concomitant pneumothorax or pneumomediastinum may also be observed

19. ETT should be inflated to fill the lateral tracheal walls - it should not be bulging. ETT has not been advanced far enough into the trachea Placement of the ETT too near the vocal cords may lead to vocal cord injury when the cuff is inflated.

20. Advancement of the ETT into the right mainstem bronchus. The left lung typically collapses when this occurs. The left mainstem bronchus is clearly visible

21. Purpose: Tracheostomy tubes are usually placed one to three weeks following ETT placement in patients requiring ongoing mechanical ventilation or tracheal suctioning

22. STOMA AT 3 RD TRACHEAL CARTILAGE TIP SHOULD BE ABOVE CARINA DOESN’T SHIFT WITH MOVEMENT

23. NORMAL POSITION [ SLIGHT ROTATION OF XRAY ]

24. COMPLICATIONS MALPOSITION TRACHEAL PERORATION-PNEUMOTHORAX/PNEUMOMEDIASTINUM TRACHEAL STENOSIS

25. Pneumothorax-straight Arrow Pneumomediastinum-curved arrow Surgical emphysema-notched arrow

26. CHEST TUBES LOCATED MEDIAL TO INNER MARGIN OF RIBS ANTEROSUPERIOR-PNEUMOTHORAX POSTEROINFERIOR-PLEURALE FFUSION

27. NORMAL POSTIONING

28. Fissure placement

29. ADVANCEMENT INTO SUBCUTANEOUS TISSUE/MEDIATINUM/ORGANS

30. tip of NG tube-10 cm caudal to GE junction [in the antrum] The tube descends in the midline, bisects the carina, passes the diaphragm in the midline and the tip resides below the diaphragm . TIP OF ND TUBE -10 cm INTO SMALL BOWEL

31. NG TUBE FORMING LOOP IN LEFT BRONCHUS BEFORE TIP REAHING RIGHT LOWER LBE BRONCHUS

32. UMBILICAL VENOUS CATHETER An umbilical venous catheter passes directly superiorly and remains relatively anterior in the abdomen. passes through the  umbilicus ,   umbilical vein , left portal vein,  ductus venosus , middle or left  hepatic vein , and into the  inferior vena cava .  The tip should lie at the junction of the  inferior vena cava  with the  right atrium .

33. UMBILICAL ARTERIAL CATHETER The catheter pass through the  umbilicus , travel inferiorly through the  umbilical artery , then in the anterior division of the  internal iliac artery , into the  common iliac artery  and then into the  aorta . The tip of the catheter should be placed in one of two locations:  high position : at T6 to T10 level  low position : at L3 to L5 level

34. umbilical arterial catheter  (midline) umbilical venous catheter  (right side)

35. umbilical venous catheter travels cranially in the  umbilical vein   the umbilical arterial catheter travels caudally in an umbilical artery to reach a common iliac vessel

36. UMBILICAL VENOUS CATHETER COMPLICATIONS If advanced too far along its intended course, the tip may end up in: left atrium and beyond (through a  patent foramen ovale  or an  atrial septal defect ) pulmonary vein /left ventricle right atrium and beyond formation of thrombus hepatic hematoma pericardiac hematom

37. TIP IN RIGHT ATRIUM

38. THANKYOU

39. REFERENCES Learning Chest Imaging-John C Pedrozo Pupo Collins J and Stern EJ: Chest radiology:The Essentials