RDGR tubes Flashcards
(37 cards)
1
Q
Why do we have endotracheal tubes?
A
- assist ventilation
- Airway control
- Prevents air from going into stomach
- Route for suctioning
- Medication administration
2
Q
Where is the placement for endotracheal tubes?
A
- tip should be 3-5 cm from carina (T5,T6,T7) with neck in neutral position
- Cuff should fill not distend lumen of trachea
3
Q
What would neck flexion and extension cause for misplacement of endotracheal tube?
A
Flexion=may cause 2 cm of descent of ETT
Extension= may cause 2 cm of ascent of ETT
4
Q
What are some complications of the endotracheal tube?
A
- placement in right main bronchus
- Tip must be 3 cm distal to level of vocal cords so vocal cords are not damaged
5
Q
What might happen if the endotracheal tube is misplaced in the right main bronchus?
A
- Atelectasis of the non-aerated right upper lobe of left lung
- Right-sided pneumothorax
6
Q
Why do we do tracheostomy tubes?
A
- Airway obstruction at or above laynx
- Long-term intubation (more than 21 days)
- Airway obstruction during sleep apnea
- When paralysis of muscles affects respiration
7
Q
Where is the placement for tracheostomy tubes?
A
- Tip halfway between stoma and carina, aprrox T3
- Not affected by flexion/extension of neck
- Cuff should fill not distend lumen of trachea
8
Q
What are the potential complications for the tracheostomy tubes?
A
- Perforation of trachea
(signs: pneumoediastinum, pneumothorax, subcutaneous, emphysema) - Tracheal stenosis (long-term)
9
Q
Why do we do Central Venous Catheters?
A
- medication adminstration
- Central venous pressure
- Placement
- No radiopaque marker
- Inserted by subclavian or internal jugular vein route
10
Q
Where is the placement for central venous catheters?
A
- CVC should reach media end of clavicle and tip medial to anterior end of first rib before descending into superior vena cava. Otherwise, may indicate arterial placement
- Indentation of the cardiac contour marks the junction between the superior vena cava and the right atrium
- no kinks in catheter
11
Q
What are the complications of the CVC?
A
- Malpositioned with tip in the right atrium or internal jugular vein (subclavian approach)
- May proved inaccurate central venous pressure readings
- May produce cardiac arrhythmias if the right atrium
- Pneumothorax
- Vein perforation
- Sharp bend in catheter
- Subclavian artery placement rather than a vein
12
Q
why do we do Peripherally Inserted Central Catheters (PICC) : non-tunneled catheter?
A
-Long term venous access
Medication adminsitration
-Blood draws
-Blood transfusions
13
Q
Where is the placement for the PICC?
A
- tip in SVC ideally but may be placed in an axillary vein if necessary
- Arm vein accessed for placement
14
Q
What are the potential complications of the PICC?
A
- Tip may become malpositioned
- Thrombosis of line
- Site infection
15
Q
Why do we do Venous Access Ports (implanted Infusion Port) Port A-Cath?
A
- Long term venous access
- Medication administration
- Blood transfusions
- Blood draws
16
Q
Where is the placement for the Venous Access Ports?
A
- Port is surgically implanted under the skin on chest or upper arm
- Tip of the line is placed in superior vena cava
- Specially designed needle is required to access the port (Huber)
17
Q
what are the complications of Venous Access Ports?
A
- Tip may become malpositioned
- Thrombosis of line
- Site infection
18
Q
Why do we do Pulmonary Artery Catheters (Swan-Ganz Catheter)?
A
- Measure cardiac output
- right heart pressure and indirectly, left heart pressure
- May measure mixed venous oxygen saturation
- Helps differentiate cardiac from noncardiac pulmonary edema
19
Q
What is the placement for Swan-Ganz catheter?
A
- Inserted into the subclavian, internal or external jugular or femoral vein and advanced until the tip is in the right atrium. Inflation of the balloon with air causes the tip to float into the proximal right or left pulmonary artery
- Tip should be within 2 cm of hila
- catheters balloon is inflated only when pressure measurements are taken, then deflated
20
Q
What are the potential complications of the swab-ganz catheter?
A
- Pulmonary infarction from occlusion of pulmonary artery
- Confined perforation or pseudo aneurysm at tip of catheter
- Symptoms: hemoptysis
21
Q
Why do we do Tunneled catheters with external ends (Perma-Cath)?
A
- Long term
- Surgically placed under the skin, tissue secures line
- One or more lumens outside the body for access, different types and uses (medication administration, total paraenteral nurition (TPN), blood draws
- Tip in SVC
22
Q
What do hemodialysis lines (Raaf, Quinton) look like?
A
- Tunnelled
- Double-lumen, large bore
23
Q
What are the placements for hemodialysis lines (Raaf, quinton)?
A
- Have 2 lumens arranged coaxially inside a single catheter between the 2 ports
- Ports are usually colour coded
- Arterial port withdraws blood proximal to the venous port through which blood is returned to the patient
- Some catheters may have one port (arterial) in SVC and the other in the right atrium (venous)
- Right internal jugular is most often used for access
- Lowest incidence of clotting
24
Q
What are complications of Raaf-quinton hemodialysis?
A
- Pneumothorax
- malposition
- Perforation of the catheter tip
- Infection
- Thrombosis of the vein containing catheter
- Occlusion of the catheter
25
Why do we do pleural drainage tubes?
- remove air or fluid from the pleural space
- Radipaque marker at site of drainage hole
- None of side holes ahould lie outside of chest wall
- Work in any position, however for optimal drainage
- Pneumothoax: anterior and superior placement
- Pleural effusion: Posterior and inferior placement
26
What are complications of pleural drainage tubes?
- malposition = inadequate drainage
- If a side hole is outside of chest wall, it may cause inadequate emphysema
- Bleeding caused by cutting of intercostal artery
- laceration of liver or spleen
- Rapid re-expansion of a collaspsed lung may lead to re-expansion pulmonary edema
27
Why do we do pacemakers?
- Correct cardiac arrhythmias
| - Electrically stimulates heart to maintain rate
28
What is the placement for pacemakers?
- Pulse genrator (battery) usually implanted in left chest wall under the skin
- May have one, two or three leads
- One lead always located in the apex of right ventricle
- Right ventricle projects to the left of the spine on the frontal projection and anterior on the lateral projection
- second lead usually in right atrium
- Third lead in coronary sinus
- Leads should have a gentle curves
29
What are the potential complications of pacemakers?
- Pneumothirax
- Fracture of leads
- Perforation of heart by leads (causes cardiac tamponade)
- Leads lost contact with ventricular wall (patient may twist generator under skin and contact is lost (twiddlers syndrome)
- *avoid abducting or elevating patients left arm for 24 hours (prevents dislodging pacemaker and leads)
30
Why do we do automatic implantable cardiac defibrillators (AICDs)?
-prevent death from tachyarrhythmias
31
What is the placement for AICDs?
- one electrode is placed in the superior vena cava, if present, the ventricle
- No kinks
- Wider more opaque segment of electrode than pacemaker leads
32
What are potential complications for AICDs?
- Leads may migrate
| - Meads may break
33
Why do we do nasogastric Tubes (Salem Sump, Levin)?
- Short - term feeding
- decompression (removal of air and gastric secretions)
- Gastric sampling
- Medication administration
- Diagnostic procedures
- Radipaque stripe breaks at a side hole, approx 10 cm from the tip
34
What is the placement of the nasogadtric tubes (Salem Sump, Levin)?
-The tip and all side holes should extend 10 cm into the stomach beyond the esophagogastric (EG) junction
(The EG junction is usally located where the left hemidiaphragm and left side of the thoracic spine meet (left cardiophrenic angle)
35
What are potential complications of nasogastric tubes (Salem Sump, Levin)?
- Malpostioning (coiling in the esophagus) (inserted into trachea, most likely to enter right main stem bronchus)
- Perforation of esophagus (rare)
- Long-term indweling can caus gastro-esophageal reflux (GERD)
36
Why do we have feeding tubes (Dobbhoff)?
Nutrition
37
What is the positioning for feeding tube (Dobbhiff)?
- weighted end
- Ideally in the duodenum
- Reduces risk of aspiration
- However, stomach placement is common
