Lines and Tubes (Chest, Cardiovascular Devices, Biliary, and Shunt)

Chest Tubes

Used when lung has collapsed away from chest wall - air/fluid is in the pleural space

Emergency procedure - large diameter tube inserted into the pleural space to allow air or fluid to escape, allows lungs to re-inflate

Chest Tube Placement

Upper thorax if for collapsed lung,

Lower thorax if for drainage of fluid,

Keep external end of chest tube below the level of the insertion site

Chest Tube Precautions

KEEP drainage collector lower than chest level,

DO NOT TIP the drainage protector,

AVOID tension on the tubing,

COVER if the seal is broken immediately cover the punction site with an airtight seal (Vaseline covered gauze works well) and call for help

Chest Tube X-Ray (image)

PICC Line

Type of central venous line, placed near heart (SVC)

PICC Line Function

Administration of medication long-term IV therapy, chemotherapy

PICC Line Pathway

starts (normally in arm) and ends at SVC just superior to the right atrium

PICC Line X-Ray (image)

Port-A-Cath

Long term IC therapy (chemotherapy),

Preserves vessel puncture site,

surgically placed,

special diaphragm disk under skin,

special right angle needle is used to puncture the diaphragm,

may be used in CT for contrast injections

Port-A-Cath placement

ends just superior to right atrium

Port-A-Cath X-Ray Image

Swan Ganz Line

Multiple lumen line, Blood gas samples, pressure readings, administering meds

Swan Ganz Line Pathway

Subclavian vein - SVC - RA - RV - Pulmonary Artery

Swan Ganz Line X-Ray (image)

Pulled Central Venous Line or PICC

Direct pressure on puncture site,

call for help,

patient in steep left latera Trendelenburg position (keeps air on the right side of the heart)

Pacemakers

temporary vs. permanent,

often two electrodes (RA and RV)

Pacemaker Pathway

Subclavian V - SVC - RA - RV, electrode wedged against RV wall

Pacemaker X-Ray (image)

Automatic Implantable Cardioverter Defibrillator (AICD)

Corrects arrhythmias and helps the heart beat more regularly

AICD positioning

One electrode in the SVC or brachiocephalic vein and the second electrode (if used) placed in the apex of the right ventricle

AICD X-Ray (image)

Intra-Aortic Balloon Pump (IABP)

Temporary treatment,

helps heart pump more blood with less energy,

Inflates during diastole which helps blood enter the coronary arteries,

Deflates during systole so that blood can reach the body

IABP X-Ray (image)

IABP marker

balloon can be seen and as a shadow and has a SMALL METALIC MARKER that is meant to be distal to the left subclavian artery

Left Ventricular Assist Device (LVAD)

Pump used when patient is in end-stage heart failure,

Helps the heart pump blood to the rest of the body,

allows patient to return home,

can be used as a bridge to heart transplant or as a permanent alternative to heart transplant

LVAD Images

Cannula for ascending aorta (white arrows); pump (blue arrows); LV cannula (red arrows)

Electrocardiogram Leads (ECG/EKG)

Can interfere with visualization of central lines and other implanted devices on image,

If able, attempt to redirect, depending on the reason for exam

T-Tube

Inserted during/post op cholecystectomy,

documents patency of common bile duct, and presence of residual gallstones

T-Tube Pathway

common hepatic duct - common bile duct - outside of body

T-Tube (image)

Ventriculoperitoneal (CSF) Shunt X-ray (image)