Skip to main content

Lines and tubes in the chest


End of CVC is in the superior vena cava,ideally at the junction with RA,this position decrease the risk of tip thrombosis and dysarthmyias... Look for complications as pneumothorax 

Pulmonary artery catheters: ideally 5
8 cm beyond the bifurcation of the main pulmonary artery in either the R or L pulmonary artery,not to extend beyond the pulmonary hilum on CXR.

ET tube: neck extension and flexion can make a tube move up to 3 cm. In neutral position tube should be 2- 3 cm above the carina...remember flexion =further ,extension=exit 

Tracheostomy tube: Tube tip should be at the level of T3. Exclude complications of pneumothorax, pneumomediastinum and subcutaneous emphysema..tracheostomy tube dose not move with neck movement 


Pleural tubes: check all side holes are within the thorax


Intra-aortic balloon pump: ideal position of the tip is just distal to the origin of the L subclavian artery on TOE, or tip in 2nd intercostal space just above the left main bronchus. If advanced not too far it may occlude the left subclavian artery and if too distal may occlude branches of the abdominal aorta. 


Umbilical venous catheters – can be utilized in neonatal resuscitation, tip should be located in the IVC beyond the ductus venosus but proximal to the RA 

Comments

Post a Comment

Popular posts from this blog

The 100 essentials in icu and anesthesia

The most visual experience in anesthesia and critical care education  The 100 essentials of anesthesia and critical care  COMING VERY SOON  stay tuned 

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...