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LINESANDTUBES

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LINES AND TUBES

ETT Tip 5cm from carina

Tracheostomy tube tip way between stoma and carina

Central venous catheter Tip in SVC

Swann-Ganz Catheter Tip in proximal R or L Pulmonary Artery

Umbilical Catheter T 12, proximal to the right atrium in the IVC(just above the diaphragm on X ray

Pleural Drainage TubeAnterosuperior for PTX;

posteroinferior for effusion

Pacemaker Tip at apex of R ventricle; other(s) in RA

Intraaortic Ballon Pump Aorta descendens

NG tube Tip in stomach

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AIRWAYS

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ETT

Tip of endotrachealtube (yellow arrow)lies well above the

carina (green arrow)

R3

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TRACHEOSTOMY

Tip of tracheostomytube (yellow arrow)lies about midwaybetween the stoma

(blue arrow) andcarina (green arrow)

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R3

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INTRAVASCULAR LINES

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CVP

Tip of central venouscatheter (yellowarrow) curves gentlydownward into

superior vena cavaUsed in critically ill

patients

For venous

access

Measurement

of central

venous pressure

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R3

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CVP

Placement beyondthe superior venacava may also bedetrimental.Arrhythmias orcardiac perforationsmay result fromplacement of lineswithin the heartIntracardiac

placement of acentral venouscatheter (arrow). Thetip (small arrow) iswithin the rightventricle

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http://www.med.virginia.edu/med-ed/mmdb/high/r/rad00106.jpghttp://www.med.virginia.edu/med-ed/mmdb/high/r/rad00106.jpghttp://www.med.virginia.edu/med-ed/mmdb/high/r/rad00106.jpg

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CVP

Close up view of

chest x-ray showing

catheter tip in the

external jugular

vein. Each cathetershould be followed

to its tip so that an

abnormality like this

one on the edge of

the film is notmissed R3

http://www.med.virginia.edu/med-ed/mmdb/high/r/rad00107.jpghttp://www.med.virginia.edu/med-ed/mmdb/high/r/rad00107.jpghttp://www.med.virginia.edu/med-ed/mmdb/high/r/rad00107.jpg

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Swann-Ganz

Catheters

Swan-Ganz catheters (pulmonarycapillary wedge pressure

monitors) are used to measure

pulmonary wedge pressures.

Pulmonary capillary wedge

pressure catheters (PCWP) are

introduced percutaneously into

the venous system. They areadvanced through the right heart

and into the pulmonary artery.

The catheter tip should ideally be

positioned no more distally than

the proximal interlobar

pulmonary arteries. A good ruleof thumb is that the catheter tip

should be within the mediastinal

shadow. Placement more distally

increases the chance of

pulmonary infarction or vessel

rupture.

Monitors

Chest x-ray showing location of Swan-

Ganz catheter tip (arrow) in the rightpulmonary artery

http://www.med.virginia.edu/med-ed/mmdb/high/r/rad00105.jpghttp://www.med.virginia.edu/med-ed/mmdb/high/r/rad00105.jpg

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Swann-Ganz

Catheters

Malpositioning of PCWPcatheters is exceedinglycommon, found inapproximately 25% ofcatheters placed. This maylead to false readings and anincreased risk for

complications.Complications of PCWPcatheter placement includepneumothorax, pulmonaryinfarction, cardiacarrhythmias, pulmonaryartery perforation,

endocarditis, and sepsis.

Improper positioning of aPCWP catheter in the distalbranches of the pulmonaryartery.

Catheters

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Catheter position The umbilical artery catheter should be

positioned at a high position above T 12. The umbilical venous catheter should ideally

be placed just proximal to the right atrium inthe IVC (just above the diaphragm on X ray

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Frontal radiograph of abdomen

shows that umbilical venous

catheter enters abdomen at

umbilicus (small arrowhead),travels in cephalad direction in

umbilical vein (double black

arrows) (note that catheters

cross just above umbilicus),

courses through left portal vein

and ductus venosus, entersinferior vena cava, and

terminates in right atrium.

Umbilical artery catheter also

enters abdomen at umbilicus

(single black arrow) but extends

inferiorly (white arrow) andposteriorly into iliac artery

before coursing superiorly in

aorta (large arrowheads).

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Used to remove eitherair in or fluid in thepleural space

Ideal position is

anterosuperior for PTX

and posteroinferior foreffusion

Pleural Drainage Tube

R3

Tip of thoracostomy

(pleural) drainagetube (yellow arrow)

lies in the apex of

the right

hemithorax. The

side hole (blue

arrow) is well withinthe chest.

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This chest tube

failed to remove the

pleural effusion due

to anterior

placement

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CARDIAC DEVICE

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Two-lead pacemaker(red circle)

shows one lead in right atrium

(greenarrow)and the second in

the right ventricle(red arrow).

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Tip of intra-aortic balloon

pump (red arrow) lies just

below top of the aortic arch

(green arrow) and heads

slightly to the right.

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Tip of intra-aortic balloon pump (yellow

arrow) lies about 2 cm from top of aortic

arch (blue arrow)

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TERIMA KASIH