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CD III > Lecture 5- Placement of Lines and Tubes > Flashcards

Lecture 5- Placement of Lines and Tubes Flashcards

1
Q

Endotracheal Tube (ET Tube)

why are they used?

A
  • assist ventilation
  • isolate trachea to permit control of airway
  • prevent gastric distension
  • provide direct route for suctioning
  • administer medications
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2
Q

Endotracheal Tube (ET Tube)

positioning

A
  • wide bore tubes w/ radiopaque marker stripe & no side holes
  • pt’s head in neutral position, the tip of ETT should be 3-5cm from carina
  • diameter of ETT should be 1/3 to 1/2 width of trachea
  • neck extension + flexion can change positioning
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3
Q

Endotracheal Tube (ET Tube)

complications with malposition

A
  • too long: tip of ETT will slide into R bronchi
  • too short: tip may damage vocal cord
  • intubation could be into the esophagus not trachea
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4
Q

Tracheostomy Tubes

when to use?

A
  • in pts w/ airway obstruction at or above level of larynx
  • resp failure using long-term intubation (> 21d)
  • airway obstruction during OSA
  • paralysis of muscles that help w/ swallowing or respiration
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5
Q

Tracheostomy Tubes

positioning

A
  • tip should be halfway between the stoma in which the tracheostomy tube was inserted and the carina
  • not affected by extension and flexion
  • size should be 2/3 of trachea
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6
Q

Tracheostomy Tubes

complications

A
  • tracheal injury (pneumomediastinum, pneumothorax, subQ emphyema)
  • cuff over inflation
  • tracheal stenosis
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7
Q

Central Venous Catheters (CVC)

describe

A
  • for venous access to instill chemo or hyperosmolar agents not suitable for peripheral venous admin
  • measurement of central venous pressure
  • to maintain and monitor intravascular blood volume
  • venous access in pts w/ difficult access
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8
Q

Central Venous Catheters (CVC)

how to see on imaging? which veins commonly used?

A
  • small & uniformly opaque w/out marker stripe
  • placed in subclavian, internal jugular, or femoral veins
  • subclavian & brachiocephalic veins join posterior to the medial ends of the clavicles
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9
Q

Central Venous Catheters (CVC)

placement

A
  • should reach medial end of clavicle before descending, tip should be medial to the anterior end of 1st rib
  • should descend lateral to the R side of spine and lie in the SVC
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10
Q

Central Venous Catheters (CVC)

complications

A
  • often malpositioned w/ internal jugular lines (into right atrium or internal jugular)
  • pneumothorax
  • venous perforation
  • placement of CVC into artery
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11
Q

Central Venous Catheters (CVC)

how would you know if you inserted into artery instead of vein?

4 components

A
  • pulsatile
  • bright red blood
  • parallels aortic arch
  • fails to descend to the right of the spine
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12
Q

Dialysis Catheters

types

A
  • temporary: quinton catheter, good for 2-3 wks
  • permanent: tunnels under skin
  • red/blue ports: red= arterial port to draw blood from; blue = venous port to push blood back in
  • large bore 13/14 French
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13
Q
A
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14
Q

Peripherally Inserted Central Catheter (PICC)

when to use?

A
  • long term venous access (months)
  • abx (most common use)
  • frequent blood draws
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15
Q

Peripherally Inserted Central Catheter (PICC)

placement

A

placed into SVC (same as CVC)

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16
Q

Peripherally Inserted Central Catheter (PICC)

complications

A
  • line may become clotted due to small diameter
  • tip may become dislodged or in wrong position
17
Q

Pulmonary Artery Catheter (Swan-Ganz catheter, PCWP catheter)

purpose

A
  • monitor hemodynamic status of critically ill patients
  • helps in differentiating cardiac vs noncardiac pulmonary edema
18
Q

Pulmonary Artery Catheter: Swan-Ganz catheter, PCWP catheter

placement

A
  • inserted into subclavian or internal jugular veins
  • longer CVC
  • tip is floated out into proximal R/L pulmonary artery (Swan-Ganz: no more than 2cm from hila)
  • catheter’s balloon is temporarily inflated only when pressure measurements are made & then should be deflated
19
Q

Pulmonary Artery Catheter: Swan-Ganz catheter, PCWP catheter

complications

A
  • pulmonary infarction (occlusion or emboli)
  • may produce a localized, confined perforation or pseudoaneurysm
  • to reduce risk of complication make sure catheter tip is proximal not distal within pulmonary artery
20
Q

Thoracotomy Tubes (Chest Tubes)

purpose

A

remove air/fluid from chest cavity

21
Q

Thoracotomy Tubes (Chest Tubes)

positioning

A
  • pneumothorax: anterosuperior
  • effusion: posteroinferior
22
Q

Thoracotomy Tubes (Chest Tubes)

how to help know where tube is positioned?

A

radiopaque stripe

23
Q

Thoracotomy Tubes (Chest Tubes)

complications

A
  • mispositioning can lead to inadequate drainage
  • side hole of chest wall can lead to air leak (subq emphysema, inadequate drainage)
  • injury to lung
  • bleeding from neurovascular injury
  • re-expansion pulmonary edema
24
Q

Cardiac Pacemaker

uses

A
  • cardiac conduction abnormalities
  • certain conditions refractory to med treatment
25
Q

Cardiac Pacemaker

placement

A
  • all pacemakers have a pulse generator
  • usually place in left anterior chest wall w/ leads entering subclavian vein
  • two leads (tips in RA and RV) or three leads (RA, RV, coronary sinus)
  • all leads should have gentle curves (no KINKS)
26
Q

Cardiac Pacemaker

complications

A
  • pneumothorax during placement
  • fracture of leads
  • perforation of heart
  • leads may be in wrong position
  • twiddler’s syndrome (pts twist leads under skin causing retraction)
27
Q

Automatic Implantable Cardiac Defibrilator (ACID)

uses

A

help prevent sudden death (secondary to tachyarrhythmias)

28
Q

Automatic Implantable Cardiac Defibrilator (ACID)

placement

A
  • usually differentiated from pacemakers by wider and more opaque segment of 1+ electrodes
  • one electrode usually placed in SVC or brachiocephalic vein and the other in the apex of the RV
29
Q

Automatic Implantable Cardiac Defibrilator (ACID)

complications

A
  • smooth curves of leads (no kinks)
  • leads may fracture
  • leads may migrate or become dislodged
30
Q

Nasogastric Tubes

uses

A
  • short term feedings
  • meds
  • decompression
31
Q

Nasogastric Tubes

placement

A
  • radiopaque stripe w/ side holes that disrupt it
  • tip & all side holes should extend 10cm into stomach beyond esophagograstic (EG)
32
Q

Nasogastric Tubes

complications

A
  • coiling of NGT in esophagus (mispositioning)
  • inserted into trachea, aspiration
  • esophageal perforation
  • long term use can cause reflux
  • always get xray to confirm placement
33
Q

Duodenal Feeding Tubes

uses

A
  • dobbhoff or flexiflo
  • for malnutrition, reduced risk aspiration, weighted tip
34
Q

Duodenal Feeding Tubes

placement

A

post pyloric sphincter

35
Q

Duodenal Feeding Tubes

complications

A
  • coiling of NGT in the esophagus inserted into trachea
  • esophageal perforation (never reinsert guidewire)
  • always get xray to confirm placement

CD III (12 decks)

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