Central lines and tubes seen on chest x-rays include central venous catheters, pulmonary artery catheters, nasogastric tubes, endotracheal tubes, and tracheostomy tubes. Correct positioning is important to avoid complications. A central venous catheter's tip should be in the superior vena cava or brachiocephalic vein. A pulmonary artery catheter is used to assess pressures but is now less common. A nasogastric tube's tip should be past the stomach. An endotracheal tube should be 5-7cm above the carina. Tracheostomy tubes lie parallel to the trachea above the carina.

1. CHEST TUBES AND LINES
DR.SAHANA.S

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

4. Normally placed CVC

5. Abnormal positions

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

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

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

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.

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.

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

28. Misplaced position
• Mediastinum widening
• air in the mediastinum – leak is occurring

30. Oesophageal Doppler probe
• Position: Mid esophagus
• Use: To monitor cardiac output via measurement of blood
velocity in the descending aorta

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

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>

42. Misplaced Leads

45. Complications
• Myocardial penetration – if electrode tip is within 3mm
of epicardial fat
• Myocardial perforation – if tip is in epicardial fat
• Pneumothorax
• Pleural effusion

46. Syndrome
• Twiddlers
• Subclavian crush

48. IABP
• Position – Approximately 2cm away from left subclavian
artery and counter pulsates
USES:
• Unstable angina
• Myocardial infarction
• Cardiopulmonary bypass