Learning objectives
1.
Review the indications for lines and tubes in the ICU setting.
2.
Identify anatomical landmarks for assessing lines and tubes on CXR.
3.
Illustrate misplaced lines and tubes and the associated complications.
Background
The chest radiograph remains the most utilised radiological investigation in the ICU and assessment of lines and tubes is a common indication.
Timely detection of misplacement and complications is vital to avoid consequent morbidity.
We will illustrate helpful landmarks and common complications visible on CXR.
Findings and procedure details
Endotracheal tube
Has a terminal hole and a cuff
The tip should lie:
Either 3-7cm above the carina with the neck in neutral position (±2cm with movement)
Or at the level of the medial ends of the clavicle
3.
Complications include:
Endobronchial intubation leading to collapse of the contralateral lung
Oesophageal intubation (diagnosed clinically,
also detected radiographically by the presence of a distended stomach)
Pneumothorax
4.
An immediate CXR is warranted after insertion
Tracheostomy tube
Half way between stoma and the carina - its position...
Conclusion
The chest radiograph is the primary tool used to evaluate line and tube position and complications.
It is vital that radiologists and ICU physicians can accurately assess them.
We have presented helpful anatomical aids and highlighted complications to be avoided.
References
Anonymised images courtesy of John Radcliffe Hospital (Oxford),
Radiology Department and Stoke Mandeville Hospital (Buckinghamshire),
Intensive Care Unit