This document discusses the positioning and complications of various tubes, lines, and devices commonly placed in critically ill patients based on chest x-ray findings. It describes the normal positioning and common errors for endotracheal tubes, tracheostomy tubes, central venous catheters, pulmonary artery catheters, chest tubes, and enteric tubes. Important complications are also summarized for each type of tube or line. The document emphasizes the diagnostic value of chest x-rays in evaluating the placement and detecting complications of these important medical devices.
Triphasic CT (TPCT) Scan of the liver is essential in view of the dual blood supply of the liver. TPCT allows characterisaiton of all liver lesions and close to pathological correlaiton by non invasive imaging alone. Additionally providing segmental vascular analysis as a surgicical guide.
Triphasic CT (TPCT) Scan of the liver is essential in view of the dual blood supply of the liver. TPCT allows characterisaiton of all liver lesions and close to pathological correlaiton by non invasive imaging alone. Additionally providing segmental vascular analysis as a surgicical guide.
Describes parts of the mediastinum and anatomical landmarks and common mediastinal pathologies and there radiological features and differentiation in a simple educational way with multiple CT examples of different cases .
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.
radiological anatomy of retroperitoneum powerpointDactarAdhikari
brief and concise on radiological anatomy of retroperitoneum
includes topic like pararenal space,perirenal space,fascial plane,retroperitoneum hematoma and sign of mass origin
Describes parts of the mediastinum and anatomical landmarks and common mediastinal pathologies and there radiological features and differentiation in a simple educational way with multiple CT examples of different cases .
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.
radiological anatomy of retroperitoneum powerpointDactarAdhikari
brief and concise on radiological anatomy of retroperitoneum
includes topic like pararenal space,perirenal space,fascial plane,retroperitoneum hematoma and sign of mass origin
USMLE CVS 001 Mediastinum anatomy medical chest .pdfAHMED ASHOUR
The mediastinum is the central compartment of the thoracic cavity, located between the lungs.
It is a three-dimensional space that houses various structures within the chest.
The mediastinum extends from the sternum (front of the chest) to the vertebral column (back of the chest) and from the superior thoracic aperture (top of the chest) to the diaphragm (bottom of the chest).
Understanding the anatomy of the mediastinum is crucial for healthcare professionals to interpret diagnostic findings and manage conditions affecting this central compartment of the thoracic cavity.
There are many interventional cardiac procedure those need a trans septal puncture of the interatrial septum. This presentation clearly elaborates everything you need to know about the TSP.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. • The chest radiograph (CXR) plays a crucial role
in critically ill patients in intensive care units.
• it is extremely useful for evaluating the
position of various tubes, lines, and other
devices and for detecting related
complications in addition to it’s diagnostic
value in cardiopulmonary disease
3. NASOGASTRIC TUBE
• 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.
4.
5.
6. • If the side holes are
positioned within the
esophagus there is
increased risk of
aspiration
• For this reason, the tip
of the NG tube should
be positioned at least
10-cm caudal to
location of the
gastroesophageal
junction
7. • insertion into the
trachea and bronchus
can cause pneumonia,
pulmonary contusion,
or pulmonary
laceration.
• Pharyngeal and
esophageal
perforations can occur
but are rare
8. Endotracheal Tube
• 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
• 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
9.
10. • Selective intubation can
cause collapse of the
contralateral lung,
hyperinflation of the
ipsilateral lung, or
pneumothorax
11. • other thing that must
also be checked for is an
aspirated tooth.
• esophageal intubation is
a dreadful complication,
which is mostly
diagnosed clinically; it
can be detected
radiographically by the
presence of an over-
distended stomach.
12. TRACHEOSTOMY
• 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 2/3rd of the tracheal
width, and the cuff should not
distend the tracheal wall
13.
14. • The possible complications are
• surgical emphysema
• pneumomediastinum
• pneumothorax
• hemorrhage
• false tract
• tracheal stenosis
• Hematoma causes widening of
the superior mediastinum.
Frontal chest radiograph shows complications
of tracheostomy: pneumothorax (straight
arrow), pneumomediastinum (curved arrow),
and surgical emphysema (notched arrow)
15. DRAINAGE TUBES
• intercostal drainage tube (ICD), is
inserted through the 4th
intercostal space in the anterior or
mid-axillary line.
• It is then directed
posteroinferiorly in cases of
effusion and anterosuperiorly in
cases of pneumothorax.
• The ICD tube has a terminal hole
as well as side holes; the side
holes can be identified on a CXR
by the interruption in the
radiopaque outline of the tube.
• No side holes should lie outside
the chest/pleura and the tube
should not float above the
effusion like a ‘lotus in the pond.
16. • Both frontal and
lateral CXRs are
necessary to ensure
proper positioning
of the chest tube.
17.
18. CENTRAL VENOUS LINE
• Central venous lines are
inserted through major
veins such as the
subclavian, internal jugular,
or femoral veins into the
superior vena cava.
• The tip of the line should
be distal to the last venous
valve, which is located at
the junction of the internal
jugular and the subclavian
veins.
• On the CXR, the position of
the valve corresponds to
the inner aspect of the first
rib
19.
20. • On the CXR, the first anterior
intercostal space corresponds
to the approximate site of the
junction of the
brachiocephalic veins to form
the superior vena cava
• On the CXR, the cavoatrial
junction corresponds to the
lower border of bronchus
intermedius
• If the line tip reaches the right
atrium, it can cause
dysrhythmia or result in
injection of undiluted toxic
medications into the heart.
21. • If the central venous line tip
abuts the venous wall there
is a risk of vessel perforation,
with resultant infusion of
fluid into the mediastinum or
pleural or pericardial space.
• On the CXR, this
complication will appear as
mediastinal widening
enlargement of the cardiac
silhouette, or a new pleural
effusion.
22. Frontal chest radiograph shows a left-sided pneumothorax following insertion of
a central venous catheter. Note that the subclavian approach (arrow) was used
for insertion of the catheter
23.
24.
25. 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.
26. • 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.
27. 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
28. • Potential complications are
• intracardiac knotting
• pulmonary infarction
• Pulmonary artery perforation
• Arrhythmias
• cardiac perforation
• placement in the inferior vena cava
29. Frontal chest radiograph shows malposition of
a Swan-Ganz catheter (arrows) in the inferior
vena cava
30. INTRA AORTIC PUMP
• The various indications are acute
myocardial infarction (MI) with
cardiogenic shock, post-coronary
artery bypass graft (high-risk cases
with low ejection fraction of <20%),
acute mitral insufficiency, and
cardiac transplantation
• The balloon is inflated with gas
during diastole and deflates during
systole, resulting in increase in
coronary blood flow and reduction
in left ventricular afterload (and
hence, reduction in myocardial
oxygen consumption)
31. • To avoid occlusion of the
left subclavian artery and
visceral and renal
arteries, its tip should be
slightly cephalad to the
adjacent carina (2nd–3rd
intercostal space).
• The balloon should not
occlude more than 85–
90% of the aortic
diameter.
Frontal chest radiograph demonstrates an
optimally positioned intra-aortic balloon pump
catheter. The catheter tip is identified by a
rectangular metallic density (arrow)
32. • Balloon rupture with air
embolization and
septicemia are rare
potential complications.
33. PACE MAKER
• 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.
• Sometimes a third lead is
placed in the coronary sinus
to pace the left ventricle
34. • A lateral CXR is
usually required
to confirm the
position of the
electrode in the
right atrial
appendage.
Frontal chest radiograph shows optimal position of a biventricular pacemaker.
Besides the electrodes in the right atrium (straight arrow) and right ventricle (curved
arrow), the third electrode is placed in the coronary sinus (notched arrow)
37. Automated implantable cardioverter
debrillator (AICD)
• Automated implantable
cardioverter debrillator (AICD) is
used in cases of recurrent refractory
ventricular tachycardia.
• It has two electrodes (one
electrode in the right atrium and
the other in the right ventricle).
• The lead is wider compared to the
pacemaker lead and has a ‘coiled-
spring’ appearance
• Complications are similar to those
with transvenous pacemakers
38. PEDIATRIC LINES
• Some catheters are only used in the pediatric
population the umbilical artery and venous
catheters.
• They are used for vascular access for exchange
transfusion; hyperalimentation; and
measurement of blood gases, pressures,
electrolytes, etc.
39. UMBILICAL VENOUS CATHETER
• The umbilical venous catheter
courses anteriorly and cephalad
in the midline, with posterior
angulation in the liver
• The umbilical venous catheter
should reach the base of the
right atrium or the cephalad
portion of the inferior vena cava
• The rule of thumb is that the tip
should be approximately at the
level of D8-D9 vertebrae. It lies
on the right side on the
anteroposterior radiograph.
• On the lateral CXR, it lies
anteriorly
40. • There should be no coiling, bend, or kink in
the catheter.
• Insertion into the hepatic vein, peripheral
portal vein left atrium, right ventricle, or
even into the pulmonary arteries can occur.
• Cardiac perforation, cardiac arrhythmias,
valvular injury, and portal vein or
pulmonary artery thrombosis are some of
the complications
42. UMBILICAL ARTERY CATHETER
• The umbilical artery catheter
should be at the level of the D6-
D10 vertebrae (high position) or
at the level of the L3-4 vertebrae
(low position) to ensure that its
tip is away from the origins of
vessels supplying vital organs
• In contrast to the umbilical
venous catheter, the umbilical
artery catheter dips initially
before it takes a path parallel to
the spine on the left side
• .On a lateral CXR, it lies
posteriorly
45. Summary
•Endotracheal tubes
Normal Position
•At least 2 cm above carina
At or below medial ends of the clavicle
Varies ±2 cm with neck movement
Common Positioning Errors
•Too high
•Mainstem bronchus intubation
•Esophageal intubation
Important Complications
•Spontaneous extubation
•Aspiration
•Atelectasis
•Pneumothorax
•Gastric/esophageal injury or perforation
46. Summary
•Tracheostomy tubes
Normal Position
•Similar tip positioning as ETT
•At least 2/3 of “smooth” portion in
trachea
Common Positioning Errors
•Too high/incomplete insertion
Important Complications
•Tracheal injury
•Pneumothorax
•Hemorrhage
47. Summary
•Central venous catheters
Normal Position
•Tip terminating over cavo-atrial junction (inferior border of
right bronchus)
Common Positioning Errors
•Ipsilateral IJ
•Contralateral brachiocephalic
•RA/RV
Important Complications
•Pneumothorax
•Vascular perforation
48. Summary
•PA catheters
Normal Position
•Tip position in proximal interlobar PA (roughly within
mediastinal shadow)
Common Positioning Errors
•Too distal positioning
•Otherwise similar to that of CVCs
Important Complications
•PA infarction
•PA rupture/dissection
•Otherwise similar to that of CVCs
49. Summary
•Chest tubes
Normal Position
•Air removal –directed anterior and superior
•Fluid removal –posterior and inferior
•All side holes completely visualized with the pleural space
Common Positioning Errors
•Incomplete insertion
•Tube kinking
•Chest wall
•Lung fissures
Important Complications
•Ineffective drainage
•Pulmonary laceration/contusion
•Pulmonary infarction
•Subcutaneous emphysema
•Reexpansion pulmonary edema
50. Summary
•Enteric tubes
Normal Position
•Roughly vertical/midline course down esophagus
•Tip and all side holes distal to GE junction
•Distal position depends on function
Common Positioning Errors
•Coiled tube
•Proximal/”marginal”
•Kinked tube
•Pulmonary placement
Important Complications
•Aspiration
•Pulmonary contusion/laceration
•Pneumothorax
•Esophageal/gastric perforation