Type:
Educational Exhibit
Keywords:
Thorax, Anatomy, Conventional radiography, Equipment, Complications, Safety, Education and training
Authors:
E. Allan1, R. Giggens1, T. Ali2, S. Bhuva1; 1Oxford/UK, 2Stoke Mandeville/UK
DOI:
10.26044/ecr2019/C-3024
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 is maintained with neck movement
- Width of the tube should be 2/3rds the tracheal width and it should lie parallel to the trachea
- Complications include:
- Pneumothorax
- Pneumomediastinum
- Haemorrhage (haematoma can cause widening of the superior mediastinum)
Nasogastric tube (NGT)
- Has multiple side holes and terminal lead balls to allow identification of the tip
- Inserted for feeding (fine bore) or aspiration (wide bore)
- For both,
the tip should lie within the stomach
- For nasojejunal (NJ) tubes the tip lies in the proximal jejunum
3.
The NGT should be seen to:
- Cross the bifurcation of the carina
- Lie under the left diaphragm
- The tip should lie at least 10cm caudal to the gastro-oesophageal junction (to prevent the side holes lying within the oesophagus,
increasing risk of aspiration)
4.
Main complication: misplacement in the bronchial tree
Chest drain
- Has a terminal hole and side holes (identified on CXR by interruption in the radiopaque outline of the tube)
- The tip and the side holes should lie within the pleural space
- Complications:
- Tube malposition - leading to surgical emphysema,
injury to the liver/spleen/diaphragm,
lung laceration
- Iatrogenic pneumothorax on removal
Central lines
- Indications include right atrial pressure monitoring,
administration of medications & nutrition,
renal replacement therapy,
long-term venous access.
Inserted into:
- Internal jugular - most commonly used.
The ideal location is within the superior vena cava with the tip orientated vertically.
Left sided catheters approach at a more shallow angle and therefore may need to be inserted further so the distal end is orientated vertically.
- Subclavian - the cleanest but difficult to visualise using ultrasound.
The catheter passes below the clavicle and the distal part is orientated vertically.
2.
Complications:
- pneumo/haemo/chylothorax,
arrhythmias,
nerve injury