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Lines and Tubes in Radiology – Radiology | Lecturio

Lines and Tubes in Radiology – Radiology | Lecturio

[Music] so there are many different lines and tubes that can be placed within a patient for a variety of different reasons let’s review what some of these lines and tubes can look like so that you’re able to recognize them on a chest x-ray we can have an endotracheal tube that’s placed for life support patients may have a tracheostomy tube which is a more permanent version of an endotracheal tube they can have feeding tubes which include a nasal gastric tube or a dhaba tube they can have central lines for administration of medications or blood draws they can have peripheral lines which are a more temporary version of a central line they can have swan-ganz catheters they can have chest tubes within the lung so these are all a conglomeration of different cardiac lines they can have specific cardiac lines actually within the heart as well so let’s take a look at what each of these look like this is an example of an endotracheal tube this is again placed for patients who are unable to breathe on their own and this is used as somewhat of a temporary measure while the patient is in the hospital the tip of the endotracheal tube should be approximately three to five centimeters above the level of the Carina neck flexion and extension can move the tip about to two centimeters up and down so it’s important to keep that in mind as you take a look at the position because you want it to remain within that three to five centimeters above the Carina here you can see the Quran has pointed out and it can be sometimes a little bit difficult to visualize and the endotracheal tube is just above this if you can’t see the Carina a tip that I sometimes use is you want to take a look at the aortic nob and the bottom portion of the aortic nob is approximately the level of the Carina so let’s take a look at this image here this patient has an endotracheal tube in place can you see the location of the center tracheal tube so when you’re working in a hospital setting these tubes can also be very difficult to identify because they can be subtle sometimes what we do is change the window level or help magnify and that can help us see it a little bit better throughout this lecture feel free to pause and take a good look at these pictures as we go through them to see if you can see the findings so here’s an magnified image of the location of the Carina so you can see the Carina here and the endotracheal tube is actually toward to the right of the Carina so this is actually within the right mainstem bronchus and is not in a good position this needs to be readjusted right away before it’s used any further a tracheostomy tube is a more permanent breathing tube that’s placed within a patient and the patient can go out of the hospital with these the tip is about three centimeters above the Carina and this is not affected by flexion and extension complications of a tracheostomy include tracheal perforation which is which happens more acutely right after the placement of the tracheostomy or you can have stenosis which is more of a long-term complication once a patient has had a tracheostomy in for a while this is an example of what a tracheostomy looks like in relation to where the Carina is so as you can see here the Carina is right around this position and the tracheostomy is in good position above it so there are two major types of feeding tubes the most commonly used is the nasal gastric tube and that’s used as a short-term feeding or medication administration tube it’s also often used in patients who have bowel obstruction and it’s used to decompress the bowel it has a tip in a side port and both should be within the stomach beyond the level of the gastroesophageal Junction complications include placement within the trachea or having a tube that’s not placed far enough with the tip remaining within the esophagus a dhaba tube is a more longer-term solution for longer-term feeding the tip is usually placed within the duodenum or the jejunum ideally although occasionally it can be placed within the stomach as well and placement assisted guide wire is often helped for positioning placement can be within the trachea and you can also have perforation with the guide wire as some of the complications associated with a job Huff tube so let’s take a look at this NG tube you can see the NG tube coiled correctly within the region of the stomach this entire area here is likely gas within the stomach so the NG tube is in good position here incidentally we see this finding here do you know what this is so this is actually an EKG lead these are very commonly seen on top of patients especially patients that are within the ICU so it’s important to recognize that this is not located within the patient it’s just an overlying lead so this is an example of a malposition nasal gastric tube where do you think this tube is so it’s actually within the Reitman mainstem bronchus so you can see here the tube remains within the lung and it’s curving towards the right so before any kind of medication or feeding is administered through this tube this immediately needs to be readjusted this is an example of a table puff tube you can see the difference between the nasogastric tube and a table puff tube because the table half has a thicker tip and this is placed within the duodenum so it curves into the stomach beyond the level of the GE junction and then you can see it takes another curve into the duodenum crossing the midline here as the duodenum would so let’s talk a little bit about central lines these are usually used for administration of medications that can’t be given through a smaller peripheral line these are larger bore lines and they’re inserted through a subclavian or a jugular approach the tip should project to the right of the spine and should remain within the superior vena cava so you can see on this image here a central line that’s in place using using an IJ approach because you can see it coming from the neck so through the internal jugular vein and then coming down and stopping in the region of the superior vena cava right here so this is a line that’s in good position let’s take a look at this line here you can see the lot the tip of the line pointed out by the arrow so where do you think this is it’s not to the right of the spine as we would expect so this line is projecting to the left of midline and it was actually due to arterial placement of the central line which really should be within the venous system so this line needs to be repositioned before it’s used so complications of central line including include a tip that’s within the right atrium so aligned that’s just placed a little further than it should be the tip could remain within the internal jugular vein so just a little proximal than it should be and if it’s in within the right atrium it actually can result in arrhythmias pneumothorax is more common with a subclavian approach and that’s because of a puncture of the lung while placed me while placing the central line or you can also cause a perforation of the vein which can lead to hemothorax so let’s take a look at this line what kind of line is this so you can see that it’s it’s a type of central line it ends in the correct location within the superior vena cava but it has this triangular shaped density associated with it so this is a port-a-cath if there’s a port that’s implanted under the skin and the port is used for drawing blood or injecting medications this is usually left in place for long term and it’s often used in patients that are undergoing chemotherapy [Music]

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