Learning objectives
•To illustrate the role of portable chest radiograph in evaluating tubes,
catheters and other devices in patients admitted in intensive care units
Background
•A variety of devices are used in the intensive care unit for long durations.
It has been reported that upto 27% of newly placed catheters or tubes were improperly positioned and that 6% resulted in a radiographically visible complication.[1]•Although many such abnormalities may not be immediately life-threatening,
some require rapid correction to avoid clinical deterioration in patients with marginal cardiopulmonary reserve.• All catheters have the potential risks of coiling,
misplacement,
knotting,
and fracture.
Hence,
it is important to periodically check that these devices are correctly...
Imaging findings OR Procedure details
•A wide variety of devices used in the ICU can be evaluated using the portable chest radiograph.
• The commonly used ones are nasogastric tube,
endotracheal tube,
tracheostomy tube,
intercostals drain,
central venous catheter,
Swan-Ganz catheter,
pacemaker and automated implantable cardioverter defibrillator.
•The portable chest radiograph not only helps to confirm correct placement of these devices,
but also helps in early detection of complications associated with their use.
•Examples of malpositioning of these devices and various radiographically detectable complications are illustrated in this exhibit.
Nasogastric...
Conclusion
•The portable CXR is invaluable for monitoring the various indwelling devices used in critically ill patients.
A systematic approach and knowledge of the radiographic features of the common indwelling tubes and lines is of the utmost importance.
References
1.Bekemeyer WB,
Crapo RO,
Calhoon S,
Cannon CY,
Clayton PD.
Efficacy of chest radiography in a respiratory intensive care unit.
A prospective study.
Chest 1985;88:691-6.2.Gray P,
Sullivan G,
Ostryzniuk P,
McEwen TA,
Rigby M,
Roberts DE.
Value of postprocedural chest radiographs in the adult intensive care unit.
Crit Care Med 1992;20:1513-8.3.Brunel W,
Coleman DL,
Schwartz DE,
Peper E,
Cohen NH.
Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position.
Chest 1989;96:1043-5.4.Webb WR.
Pulmonary edema,
the acute respiratory distress syndrome and...