2. COMMON LINES SEEN ON CXRY
• Central venous catheters
• Pulmonary artery catheter – Swartz Ganz catheter
• Nasogastric Tube
• Nasoenteric Tube
• Intercostal drain
• Endotracheal tube
• Tracheostomy tube
• Oesophageal Doppler tube
3. CENTRAL VENOUS CATHETER
Function
• To monitor right atrial pressure
• Fluid infusion/ nutrition
• Drug administration
Position
• SVC or Brachiocephalic vein
8. Misplaced lines causes…
• Tip too High- Inaccurate right atrium monitoring
pressures
• Tip too low – In Right Atrium can cause arrhythmia and
Cardiac Tamponade
• Vessel wall perforation
• Infusion of fluid into mediastinum/pleural space
• Pneumothorax
9.
10.
11. Swartz Ganz Catheter
• Also known as pulmonary arterial line commonly
• To assess left atrial pressure and cardiac output
• Very important in ICU patients to distinguish between
cardiac and non cardiac pulmonary edema
• Now a days not much in use in regard with patient
outcome
12.
13. Misplaced lines causes…
• Distally placed tip will cause Pulmonary infarction
• Proximallly placed in right ventricle -- Arrythmia
14. NASOGASTRIC TUBE
• Side holes of the tube in the NG tube extend around 5 cm
so the tube should be atleast 10 cm beyond the OG
junction
• Uses:
1. Gastric decompression
2. Gastric aspiration
3. Nutrition
15.
16.
17. Misplaced Tubes causes..
• If it enters trachea – ARDS
• If still in oesophagus – Can cause regurgitation
18. Nasoenteric Tube
• These feeding tubes are thin plastic catheters with a
mercury / tungsten filled tip.
• The optimum position for the tip is distal to the pyloric
sphincter.
19.
20. Misplaced tube causes..
• The tube is very thin so caution should be taken while
inserting the tube
• It may coil itself pharynx , Oesophagus or stomach
• It may enter trachea or right main bronchus
21. Endotracheal tube
• USE: Assisted ventilation
• The tip of an ETT will be in a satisfactory position if it
approximates to the level of the medial ends of the
clavicles
• Ideal position is 5–7 cm above an adult’s carina when the
head is held in the neutral position.
• And if carina is not visible in 95% people it is situated
at T5-T7 vertebra
22. Position changes
• The ETT can move up or down
• Flex the neck and the tip can move 1.9 cm I,e ~2cm
downwards.
• Extend the neck and it can move 1.9 cm I,e ~2cm
upwards.
• Rotate the neck and it can move 0.7 cm upwards.
23.
24.
25.
26. Malposition
• Tip of right main bronchus:
1. Left lung collapse
2. Right upper lobe collapse
3. Right lung overdistension/pneumothorax
• Tip in Oesophagus:
1. ETT lateral to tracheal air shadow
2. Oesophagus distended with air
3. Stomach distended with air
27. Tracheostomy tube
• Tracheostomy tube lies parallel to the long axis of the
trachea
• The tip lies several centimeters well above carina
• The inflated cuff should not extend lateral walls of
trachea
30. Oesophageal Doppler probe
• Position: Mid esophagus
• Use: To monitor cardiac output via measurement of blood
velocity in the descending aorta
31.
32. Intercostal Drain
• Used in pneumothorax
• Position:
1. if its placed superiorly I,e towards apex – Pneumothorax
2. If tis placed inferiorly I,e towards cardiophrenic border
– Pleural drainage
• Correct position:
On entering the pleural cavity - gush of air is felt
• Misplacement - On connecting it with the bag – if bubble
is present then its in the lung parenchyma
33.
34.
35.
36. Pacemaker
SINGLE OR DUAL CHAMBER
Single chamber –nowadays used less frequently
• used for atrial or ventricular dysarrythmia
• Atrial – positioned in right atrial appendage
• Ventricular – Electrode placed against myocardium at
apex of right ventricle
37. Pacemaker
Dual pacemaker
• Attempts to synchronize atrial and ventricular system
• One electrode @ Right atrium
• Other electrode @ apex of right ventricle
Sometimes a third lead is also noted
• Third –coronary sinus <Biventricular pacing>
45. Complications
• Myocardial penetration – if electrode tip is within 3mm
of epicardial fat
• Myocardial perforation – if tip is in epicardial fat
• Pneumothorax
• Pleural effusion
48. IABP
• Position – Approximately 2cm away from left subclavian
artery and counter pulsates
USES:
• Unstable angina
• Myocardial infarction
• Cardiopulmonary bypass
Editor's Notes
Svc commences at right first anterior intercostal space
Postioned shud nt project 2cm beyond the mediastinal outline