What do respiratory tubes do?
provide airway potency-suction access-mechanical ventilation
What are endotracheal tubes used for?
- upper airway obstruction
- impending gastric acid reflux/aspiration
- tracheobronchial lavage
Where is an endotracheal tube placed?
Inserted into the nose or mouth or tracheostomy and ends 1-2 inches superior to the carina where the end cuff is inflated to keep it from moving
What can an endotracheal tube cause?
Atelectasis- blockage of gases into left lung if inserted too far
What is an endobrachial tube used for?
To provide ventilation to one lung
Where does an endobrachial tube end?
in one of the main stem bronchi
What are Thoracostomy tubes used for?
AKA chest tubes-used to drain fluid or air from the intrapleural space and mediastinum
Where are thoracostomy tubes inserted to drain fluids?
5th-6th intercostal space since the fluids tend to sit near the base of the lung
Where are thoracostomy tubes inserted to remove air?
2nd-3rd intercostal space- apical region since the air will rise
What diagnoses would require thoracostomy tubes?
- pneumothorax-air in pleural space
- hemothorax-blood in pleural space
- pleural effusion- fluid in pleural space
- empyema-pus in pleural space
What is a central venous line?
A catheter inserted into a large vein
What are CV lines used for?
chemotherapy, nutrition, drug administration, manage fluids, transfusions
What types of CV lines are available?
-percutaneous catheters ( subclavian insertion cath)
-implanted access ports (infusaport, port-a-cath, mediport)
-externally tunneled catheters (Brovac-hickman-Goshing)
-peripherally inserted central catheter (PICC line)
all available in single, double and triple lumens
What is the goal of a CV?
to position the catheter tip in a central vein
Where should the catheter tip of a CV be located?
in the superior vena cava-approx 2-3in above the right atrial junction
Where should the CV line be inserted?
The most common insertion in into a subclavian vein, also the internal jugular and femoral veins
What is a common insertion site for PICC lines?
peripherally into an anticubital area
What is another name for a Pulmonary Arterial (PA) Catheter?
Describe a PA catheter
- incorporates a small electrode at the distal end to monitor PA pressure
- access to rt ventricle allows arteriole approach
- distal tip ends in one of the 2 pulmonary arteries
Describe the balloon on the distal tip of a PA catheter
- balloon inflates and allows tip to float and wedge in pulmonary artery
- measures the pressure then the balloon deflates
What are potential complications from an incorrectly placed CV line?