The document discusses various lines, tubes, and devices commonly seen on radiological imaging. It provides details on the correct positioning and potential complications of nasogastric tubes, endotracheal tubes, tracheostomy tubes, central venous catheters, pulmonary artery catheters, intra-aortic balloon pumps, pacemakers, and intercostal tubes. Radiographs are included illustrating both proper positioning and examples of complications for some of these devices.
Right Paratracheal Stripe
Posterior wall of the bronchus intermedius
Left Paratracheal Stripe
Left subclavian artery border
Posterior-superior junction line
Brief discussion on ultrasonography of the chest: Benefits, Techniques and Instrumentation, Normal Anatomy, Diagnostic US of the chest, Limitations of Thoracic US, US based differential diagnosis, Take home points.
RADIOLOGY OF LINES AND TUBES IN INTENSIVE CARE SEMINAR.pdfTalabathulaMadhuri1
Many medical devices are used in intensive care unit for critically Ill patients for longer duration.
Each of them are a double edged sword,that means they are intended to save life and if they positioned in wrong place or if they are misplaced after insertion it may lead to life threatening complications.
So it is essential for a radiologist to know about the correct position as well as malpositions and its associated complications.
Right Paratracheal Stripe
Posterior wall of the bronchus intermedius
Left Paratracheal Stripe
Left subclavian artery border
Posterior-superior junction line
Brief discussion on ultrasonography of the chest: Benefits, Techniques and Instrumentation, Normal Anatomy, Diagnostic US of the chest, Limitations of Thoracic US, US based differential diagnosis, Take home points.
RADIOLOGY OF LINES AND TUBES IN INTENSIVE CARE SEMINAR.pdfTalabathulaMadhuri1
Many medical devices are used in intensive care unit for critically Ill patients for longer duration.
Each of them are a double edged sword,that means they are intended to save life and if they positioned in wrong place or if they are misplaced after insertion it may lead to life threatening complications.
So it is essential for a radiologist to know about the correct position as well as malpositions and its associated complications.
Tetralogy of Fallot
Tetralogy of Fallot with Pulmonary
Stenosis
TETRALOGY OF FALLOT WITH CONGENITAL PULMONARY ATRESIA
Tetralogy of Fallot with Absent Pulmonary Valve
This lecture details the science of sepsis care in 2015 with compliments to the multiple online sources used, some of which are other lectures on SlideShare.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
2. Fun Facts From This Day:
• 1925 John T. Scopes found guilty of teaching evolution in the “Scopes
monkey trial”, Dayton, Tennessee, fined $100 & costs
• 1969 Neil Armstrong (8/5/1930 – 8/25/2012) becomes the first person
to step on the Moon at 2:56:15 AM (GMT)
6. Did you know?
•Possibly the worst campaign slogan in history belongs to Al
Smith, who was against prohibition. To show his support
for the creation, distribution, and sale of alcohol, he
advertised: “Vote for Al Smith and he’ll make your wet
dreams come true.”
•George Washington blew his entire campaign budget on
160 gallons of liquor to serve to potential voters.
http://www.factretriever.com/us-presidential-elections-facts
7.
8. Introduction
•The American College of Radiology (ACR) recommends a
CXR immediately following placement of indwelling tubes,
catheters and other devices to check the position and
detect procedure related complications.
•Some studies have shown 27% of newly placed catheters
or tubes were improperly positioned and that 6% resulted
in a radiographically visible complication of the
intervention.
9. Nasogastric Tube
• The nasogastric (NG) tube is inserted for either feeding the
patient or for aspiration of gastric contents, and for these
purposes the tip should lie within the stomach.
• The NG tube has multiple side holes. There are terminal lead
balls to facilitate identification of the tip.
• Ideally, the tip of NG tube should lie with its side holes in the
gastric antrum.
• Pushing air into the NG tube while auscultating with a
stethoscope over the stomach is the usual method by which
correct positioning in the stomach is confirmed.
10. Nasogastric Tube
•The tip of the NG tube should be positioned at least 10-cm
caudal to location of the gastroesophageal junction.
•Other naso/oro-enteric tubes are also encountered.
•The tip of a nasoduodenal feeding tube should be inserted
at least 10-12 cm into the small bowel.
13. •Frontal radiograph
of the chest shows a
NG tube forming a
loop in the left
bronchus (arrow)
before the tip
(arrowhead) reaches
the right lower lobe
bronchus
14. Endotracheal Tube
•The endotracheal (ET) tube is inserted for ventilation of
both the lungs and for prevention of aspiration.
•It has a terminal hole and a cuff.
•The satisfactory position of an ET tube in the neutral
position of the neck is with the tip 5-7 cm above the
carina. The location can vary approximately 2 cm in the
caudal or cephalad directions with neck flexion and
extension, respectively.
15. Endotracheal tube
• When the carina is not visible, the tip of the ET tube should be
approximately at the level of the medial ends of the clavicle.
• It should lie midway between the larynx and carina so that
injury to either structure or complications like inadvertent
extubation or selective main-stem bronchus intubation are
avoided.
• Selective intubation can cause collapse of the contralateral lung
• Tracheal stenosis can occur following long-term tube placement.
16.
17. • Frontal chest radiographs show an endotracheal tube in the right main
bronchus (arrowhead in A), causing hyperinflation of the ipsilateral
lung and partial collapse of the left lung (curved arrow in A). After
withdrawal of the tube into the trachea (arrow in B), the left lung has
inflated
18. Tracheostomy Tube
• The tip of the tracheostomy tube should be half way between
the stoma and the carina, at the level of the D3 vertebra.
• Unlike the ET tube, its position is maintained with neck flexion
and extension.
• The width of the tube (diameter) should be 2/3 of the tracheal
width, and the cuff should not distend the tracheal wall. It
should lie parallel to the trachea.
• Complications: Surgical emphysema, pneumomediastinum,
pneumothorax, hemorrhage, false tract, and tracheal stenosis.
Hematoma causes widening of the superior mediastinum.
21. Endotracheal Tube
•Correct position
• ETT tip 5 cm +/- 2 cm above carina
• i.e. at level of medial ends of clavicles
•Complications
• selective intubation (contralateral lung collapse/hyperinflation of
ipsilateral lung/pneumothorax)
• tooth aspiration
22.
23. Central Venous Catheter
• Correct position
• CV line tip in the superior vena cava or at the cavo-atrial junction
• i.e. at level of 1st anterior intercostal space above carina
• Complications
• insertion into right atrium or ventricle (non-bacterial thrombotic endocarditis
/ dysrhythmias / myocardial perforation)
• mediastinal hematoma secondary to vessel perforation
• Pneumothorax
• hemothorax
• central line-associated bloodstream infection
• deep venous thrombosis
24. • Diagrammatic
representation of the
last valves in the
internal jugular vein
(curved arrow) and
subclavian veins
(notched arrow). The
valves are located near
the inner aspects of the
first ribs. The
brachiocephalic veins
join to form the superior
vena cava (straight
arrow) near the 1st
anterior intercostal
space. The cavoatrial
junction (arrowhead) is
where the superior vena
cava crosses the
bronchus intermedius
27. • Frontal chest radiograph
of a patient who was
receiving fluids through
a right jugular central
venous catheter
(arrows) shows an
opaque right
hemithorax (which was
a fresh finding
compared to earlier
normal radiographs).
This was due to vessel
perforation by the
catheter and resultant
accumulation of fluid in
the pleural space
28. Bronchial Stents
•Bronchial stents are occasionally seen in patients who have
undergone lung transplantation and have developed a
stricture at the anastomosis between the native
tracheobronchial tree and the transplanted one.
•These stents may be metallic and easily recognized, or they
may be composed of various plastic materials and be hard
to recognize, especially if no history of stent placement or
lung transplantation has been given
29.
30. Implantable Loop Recorder
• The implantable loop recorder (ILR) is a subcutaneous, single-
lead, electrocardiographic (ECG) monitoring device used for
diagnosis in patients with recurrent unexplained episodes of
palpitations or syncope, for long-term monitoring in patients at
risk for or with documented atrial fibrillation (AF), and for risk
stratification in patients who have sustained a myocardial
infarction (MI) and those who have certain genetic disorders.
• Contraindicated by the presence of an active infection or a
bleeding diathesis may preclude implantation.
31.
32. Pulmonary Artery (Swan-Ganz) Catheter
• The Swan-Ganz catheter is a flow-directed balloon-tipped
pulmonary artery catheter.
• The balloon is inflated to measure the capillary wedge pressure.
• This catheter is widely used for monitoring circulatory
hemodynamics in the management of a variety of critical
illnesses.
• Initially developed for the management of acute myocardial
infarction (AMI), it gained widespread use in the management
of a variety of critical illnesses and surgical procedures.
33. Pulmonary Artery Catheter
•Data from the Acute Decompensated Heart Failure
Syndromes (ATTEND) Registry involving 4842 patients
showed appropriate PAC use reduced in-hospital mortality
in patients with acute heart failure syndromes, particularly
those with lower systolic blood pressure or who received
inotropic therapy.
•Overall, the literature does not show a positive effect on
patient outcome with PAC use.
34. Pulmonary Artery Catheter
•To measure pulmonary artery pressure and capillary
wedge pressure, the tip of catheter needs to be in the right
or left pulmonary artery.
•To avoid complications, the tip of the Swan-Ganz catheter
must not be more than 1 cm lateral to the mediastinal
margin. The rule of thumb is that the catheter should not
extend beyond the pulmonary hilum on the CXR; else, it
should be retracted.
35. Pulmonary Artery Catheter
• The complication rate of pulmonary infarction is reduced
when the balloon is inflated only during pressure
measurement and insertion.
•Potential complications are intracardiac knotting,
pulmonary infarction, pulmonary artery perforation,
arrhythmias, cardiac perforation, and placement in the
inferior vena cava
36.
37.
38. •Frontal chest
radiograph shows the
tip (curved arrow) of a
Swan-Ganz catheter
(straight arrows) lying
in the descending
branch of the right
pulmonary artery. The
right paracardiac
opacity is due to
pulmonary infarction
41. Intra-aortic Balloon Pump (IABP)
•Intra-aortic balloon pump (IABP) is a long-balloon
temporary circulatory assist device that works on the
principle of cardiac counter-pulsation.
•The IABP is used to support the circulation.
•The balloon, approximately 25-cm long, is mounted on a
catheter. The catheter tip is visible as a 3 x 4-mm
rectangular metallic density while the rest of the catheter
is radiolucent
42. Intra-aortic Balloon Pump (IABP)
• The balloon is radiolucent but the tip has a radio-opaque
marker.
• Device is comprised of a catheter introduced via the femoral
artery, which extends retrogradely to the proximal descending
thoracic aorta.
• The balloon is rapidly inflated at the beginning of diastole and
rapidly deflated at the end of diastole, , resulting in increase in
coronary blood flow and reduction in left ventricular afterload
(and hence, reduction in myocardial oxygen consumption)
43.
44. Intra-aortic Balloon Pump (IABP)
• As the balloon forcibly inflates it displaces blood both forwards
and backwards, known as diastolic augmentation.
• It provides not only additional forward momentum to the blood
in the distal descending aorta but more importantly increases
perfusion to the vessels arising from the arch of the aorta, most
importantly the coronary arteries which are perfused primarily
during diastole.
• This has a dual effect: it firstly decreases left ventricular
afterload through a vacuum effect, decreasing myocardial
oxygen requirements, and secondly increases myocardial
perfusion (during diastole)
45. Intra-aortic Balloon Pump (IABP)
•To avoid occlusion of the left subclavian artery and visceral
and renal arteries, its tip should be slightly cephalad to the
adjacent carina (2 nd -3 rd intercostal space). The balloon
should not occlude more than 85-90% of the aortic
diameter.
47. Case courtesy of Dr Jayanth Keshavamurthy, Radiopaedia.org, rID: 35640
48. Complications of IABP
• Complications can be divided into those relating to balloon
function and those related to balloon positioning.
• Function
• platelet and red blood cell destruction
• aortic or large vessel arterial dissection during insertion
• distal embolisation (this can be to the brain if positioning is too proximal)
• Positioning
• aortic or large vessel arterial dissection during insertion
• obstruction of the left subclavian artery or renal arteries
• Balloon rupture with air embolization and septicemia are also
rare potential complications.
49. Pacemakers
• Pacemakers are used in cases of severe sinus node dysfunction,
complete heart block, and various arrhythmias.
• They have two main elements: a pulse generator and a lead
wire with electrodes.
• The single-lead pacemaker is the most basic type and is
positioned with its tip in the right ventricular apex.
• An atrioventricular two-lead sequential pacemaker has one
electrode in the right atrium and the other at the right
ventricular apex.
50. • Frontal chest radiograph (A) shows the optimal position of the electrode of a single-lead pacemaker. The
electrode has been placed in the right ventricular apex (straight arrow). Frontal chest radiograph (B) shows a
two-lead pacemaker that has one electrode in the right atrium (arrowhead) and the other at the right
ventricular apex (curved arrow)
51.
52.
53. Pacemakers
• Sometimes a third lead is placed in the coronary sinus to pace
the left ventricle
• It is not feasible to insert an electrode in the left side of the
heart due to the high pressures in these chambers.
• Temporary epicardial wires are sometimes inserted during
cardiac surgery; the tips of these wires resemble a corkscrew.
They can be removed easily.
• A lateral CXR is usually required to confirm the position of the
electrode in the right atrial appendage. The tip points anteriorly
when correctly positioned.
54. Pacemakers
• Correct position
• single chamber: electrode tip in right atrial appendage (atrial pacing) or right
ventricular apex (ventricular pacing)
• dual chamber: electrode tips in right atrium and right ventricular apex
• biventricular: electrode tips in right atrium, right ventricle and coronary sinus
• implantable converter defibrillator: electrode tip in apex of right ventricle
• Complications
• lead malposition (dysrhythmias)
• Pneumothorax
• myocardial perforation
• lead fracture
61. Intercostal Tube / Catheter
• Correct position
• intercostal tube tip lies between visceral and parietal pleura
• anterosuperiorly to drain pneumothorax
• posteroinferiorly to drain pleural effusion or haemothorax
• Complications
• placement into lung parenchyma, interlobular fissure or subcutaneous tissue
• mediastinal or abdominal visceral trauma
• re-expansion pulmonary oedema
62. Devices in Thoracic Imaging
• Many devices are regularly seen in radiology on plain film and CT
• Pleural devices such as pigtail catheters, plombage, thoracostomy tubes
• Tracheal/bronchial/esophageal devices such as ET tubes, NG/OG tubes,
stents, pH probes, tracheostomy tubes, endobronchial valves/coils
• Vascular devices such as dialysis catheters, central lines, Swan-Ganz
catheters
• Cardiac devices such as pacemakers, IABP, Impella
• Others: Antibiotic spacer, pericardial drain, diaphragmatic pacemaker
65. Pleural Devices
•Thoracostomy (chest) tubes are commonly used for
evacuating fluid or air from the pleural space.
•They vary from 10–40 F in size, depending on the viscosity
of the material to be evacuated, and the preferences of
the individual physician involved in the treatment of the
case.
•Usually placed anterosuperiorly to evacuate a
pneumothorax and posteroinferiorly for fluid collections
66. Pleural Devices
•The normally positioned tube lies on the surface of the
expanded lung, between the visceral and parietal pleurae.
•Pigtail catheters may be used in place of standard
thoracostomy tubes, and they are popular for empyema
drainage and for installation of medication for treatment
of an empyema
67. Frontal view of the chest
shows a
pigtail catheter that had been
inserted under
fluoroscopic guidance into a
loculated right
empyema for instillation of
urokinase and
fluid drainage.
68.
69. Plombage
• In the era before antibiotics, a variety of pleural devices were
used in the treatment of tuberculosis.
• These include “ping-pong” ball plombage and wax plombage.
Their appearance is quite dramatic, and they may occasionally
be encountered in an older patient.
• Plombage was a surgical method used prior to the introduction
of anti-tuberculosis drug therapy to treat cavitary tuberculosis
of the upper lobe of the lung.
• The term derives from the Latin word "plumbum" (lead) and
refers to the insertion of an inert substance in the pleural space.
70. Plombage
• The underlying theory of plombage treatment was the belief
that if the diseased lobe of the lung was physically forced to
collapse, it would heal quickly.
• There were positive results in tuberculosis therapy following
plombage in the decades of the 1930s, 1940s and early-1950s.
However, with the introduction of drugs which were effective in
destroying the tuberculosis bacterium (Mycobacterium
tuberculosis), plombage treatment fell into disfavor.
• The technique involved surgically creating a cavity underneath
the ribs in the upper part of the chest wall and filling this space
with some inert material.
71.
72. http://www.nejm.org/doi/full/10.1056/NEJMicm0707466#t=article
Radiographic and computed
tomographic (CT) images of the chest
(Panels A and B, respectively) revealed
the balls, most of which were lucent
(Panel C) and some of which had broken
inside the pleural space. Muddy fluid
was observed inside some of the balls,
which was consistent with the high-
density fluid seen inside the balls on the
CT image (arrows in Panel B).
Pseudomonas aeruginosa was cultured
from both the fluid in the balls and the
patient's blood.
76. Tracheal/Bronchial/Esophageal Devices
•Endotracheal intubation is a lifesaving procedure, but it
can also be life threatening if the tube is incorrectly
positioned.
•For adults, the tip of the tube should be situated
approximately 5 cm above the tracheal carina, so that
excursions of 2 cm upward or downward (with neck
extension or flexion) can be safely accommodated.
77. Tracheal/Bronchial/Esophageal Devices
•The carina may not be visible on every image, but the
aortic “knob” usually is.
•The carina is just caudad to the aortic arch, so that if the
tip of the endotracheal tube is just above the aortic arch, it
is in good position, midway between the vocal cords and
the carina.
78. Tracheal/Bronchial/Esophageal Devices
• Most often malpositioned in right mainstem bronchus because
of shallower angle right main bronchus makes with trachea than
does left mainstem bronchus
• Right mainstem bronchus intubation will lead to atelectasis of
entire left lung and hyperinflation right lung
• Bronchus intermedius intubation may lead to atelectasis of
entire left lung and the right upper lobe
• Esophageal intubation may be suspected if tube deviates from
the tracheal air shadow and there is a dilated esophagus and
stomach
79. Tracheal/Bronchial/Esophageal Devices
• Complications
• Aspiration/pneumonia
• Foreign body aspiration
• Broken teeth
• Dentures
• Fillings
• Pneumothorax, pulmonary interstitial emphysema,
pneumomediastinum from barotrauma
• Rupture of alveoli from high pressures with mechanical ventilation
• Sinusitis from prolonged nasotracheal intubation
82. Passy Muir Valve: Case courtesy of Dr Jayanth Keshavamurthy, Radiopaedia.org, rID: 27899
83.
84. Passy-Muir valve
•Patient has had complete laryngectomy for squamous cell
cancer of larynx. There is a Passy Muir Valve covering the
tracheostomy.
•When you look at trachea the air overlying larynx is wider
than usual. This should clue you into it.
•When placed on the hub of the tracheostomy tube or in-
line with the ventilator circuit, the Passy-Muir Valve
redirects air flow through the vocal folds, mouth and nose
enabling voice and improved communication.
87. Left Ventricular Assist Device
• The left ventricular assist device, or LVAD, is a mechanical pump
that is implanted inside a person's chest to help a weakened
heart pump blood throughout the body.
• Bleeding is the most common postoperative early complication
after implantation or explantation of LVADs, necessitating
reoperation in up to 60% of recipients.
• One device, the HeartMate XVE, is designed with a biologic
surface derived from fibrin and does not require long term
anticoagulation (except aspirin); unfortunately, this biologic
surface may also predispose the patient to infection through
selective reduction of certain types of leukocytes.
91. Impella Device
• The Impella device is a catheter-based cardiac-assist device with a small
pump mounted at its tip. The catheter can be introduced percutaneously
via the femoral artery or may be inserted directly into the aorta.
• The pump can be positioned in the left ventricle (or rarely in the right
ventricle) to provide a temporary increase in cardiac output.
• The pump rotates at about 40,000 rpm and can generate a stroke volume
up to 2.5 L/min. Unlike the IABP, the effectiveness of the Impella does not
depend on preexisting cardiac performance. The indications for the Impella
are similar to those for the IABP.
• Impella CP does 3.5 L/min and the Impella 5 does 5 L/min
• The Impella device has also been used in conjunction with the IABP or with
ECMO
92.
93. Case courtesy of Dr Jayanth Keshavamurthy, Radiopaedia.org, rID: 39058
97. CardioWest total artificial heart
• Note the four prosthetic valves and the two coil, reinforced
polyurethane tubes carrying pulses of compressed air to the
two artificial ventricles.
• Approved as a bridge to donor heart transplant for patients
dying from end-stage biventricular heart failure.
• A TAH is a "last resort" device. This means only people who have
tried every other type of treatment, except heart transplant, can
get it. TAHs aren’t used for people who may benefit from
medicines or other procedures.
• Issues with blood clots, bleeding, infection, device malfunction