R110 Ch 15 Chest Tubes and Lines

Endotracheal Tube

• utilized for intubation (assisted respiration)

• properly placed 3-5 cm superior to the carina

• most common malpositioning is into the right main bronchus

• indications include a need for mechanical ventilation or presence of a parenchymal disease or shock

Thoracostomy Tube

"chest tubes" utilized to drain intrapleural space and mediastinum air/fluid accumulation in clinical indicated cases such as pneumothorax, hemothorax, pleural effusion, and empyema

common complications and common insertion sites of thoracostomy tubes

complications: punctured lung, bleeding, infection, shock

insertion: between 5th/6th costal space, can be as high as 4th and as low as 8th laterally and mid axillary

what imaging considerations are applied to a chest tube?

• chest radiograph should be performed semi erect or fully upright

• inspiration/expiration images can be applied to show pneumothorax progression

Central Venous Pressure Lines are also known as

Central Venous Catheters OR Venous Access Lines

what is a CVP/CVC?

a central venous access catheter (catheter inserted into a large vein)

If a CV line is placed in a peripheral vein what is it called?

Peripheral Inserted Central Catheter PICC line

What is the function of most central venous catheters?

• manage fluid volume

• measure arterial pressure

• conduit for blood analysis

• assist on blood transfusions

• administer drugs

• chemotherapy

What are types of CVL that enter in the subclavian?

Hickman, Groshang, Broviac, Portacath

What are two types of CVLs that do not enter through the subclavian?

PICC line and IVC line

what is a Hickman line?

long term double or triple lumen CVL that is tunneled which can be used to administer drug therapy and chemo treatments

what is a Groshong?

• tunneled, long term CVL

• distal end exits the body

• contains a 3 way valve allowing for decreased chances of blood clotting (less heparin use)

• utilizing the subclavian

what is a Broviac?

very similar CVL to the Hickman but smaller and commonly utilized in pediatrics for long term medication delivery in a tunneled CVL through the subclavian

What is a portacath?

a cvl that is placed entirely under the skin allowing for less infection risk and more long term medication treatment, distal end allows for needle access to a membranous drum can be single or double lumen and utilize subclavian access

What is a swan ganz catheter otherwise known as?

pulmonary arterial catheter

what does a pulmonary arterial catheter do?

ismall catheter used to monitor pulmonary arterial pressure, with a small electrode and balloon at the distal end, inserting through the subclavian, to the SVC, to the right side of the heart, through the pulmonary artery. Risk is inserting through to the left ventricle which can lead to major complications

what catheter leads to the safest way to evaluate left ventricle arterial pressure?

pulmonary arterial catheter, or swan ganz catheter

What do inferior vena cava filters do?

they trap blood clots

what type of wire is a IVC filter?

small mesh, thin wire with a cage at the distal tip to hold blood clots

what is the Greenfield filter an example of?

an IVC filter to trap blood clots

what is the primary use of an NG tube?

to remove air/fluid from the stomach

what are two types of NG tubes?

Levin Tube - single lumen

Salem Pump - radiopaque double lumen

what is the insertion point for the Hickman, groshong, broviac, portacath, swan ganz, vascath?

anterior chest wall

where does the distal end of the catheter land for the Hickman, groshoong, broviac, porta Cath, and PICC line?

2-3 cm above the right atrium

what type of tube is the chest tube?

intrapleural

what type of tubes are CVC lines?

hickman, groshong, broviac, portacath, PICC

what type of line is the vascath?

Pheresis Catheter

what is the point of insertion for the PICC line?

Peripheral vein (commonly by the elbow or antecubital space)

where does tip placement land for the Vascath?

IVC

where does tip placement land for the swan ganz?

pulmonary artery (right side)

where does the Greenfield line (IVC) insert and end?

inserts in the groin and tip placement ends 1-2 inches superior to the IVC bifurcation

what is the main function of the Vascath?

Dialysis

which line is this, where does the tip placement end?

the pulmonary artery catheter, right pulmonary artery, entering through a large vein including internal jugular, subclavian or femoral

which line is this, where does tip placement begin and end?

PICC line, entering into a large peripheral vein (commonly in the elbow), leading to the subclavian, considered a CVC, landing 2-3 cm above the right atrium

what is this line called?

Port a Cath

what line is this (it includes a three way valve and catheter tip)?

Groshong Central Venous Line

what line is this (it includes a double lumen or triple lumen)?

Hickman Subclavian Central Venous Line

what line is this?

IVC/Greenfield filter