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 Posted: Sat Mar 05, 2005 10:40 pm Post subject: Check out the Interesting Cases |
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Chest tubes lines and drains
| Quote: | Intercostal Chest Drain
Purpose: To drain air or fluid from within the pleural space.
Correct position: The distal tip should be within the free air or fluid to be drained, ensuring side holes are also within the pleural space.
Incorrect position: Abutting mediastinum or other major structure, eg. Left or right ventricle, lung fissure, apex or base.
Complications: Perforation of major structure on insertion or pneumothorax on removal.
Central Venous Pressure (CVP) Line
Purpose To make haemodynamic measurements, guide fluid therapy and administer drugs centrally.
Correct position Above the junction of the superior vena cava (SVC) and right atrium.
Incorrect position In the right atrium or across into a vein adjacent to the access vein.
Complications Perforation of the SVC, right atrium or pericardium or, more commonly, to cause a pneumothorax when establishing access.
Pulmonary Artery Catheter
Purpose Also known as a Swann-Ganz catheter or right heart catheter.It’s purpose is to make haemodynamic measurements, in particular, pulmonary artery pressure and cardiac outputs.
Correct position The distal tip should be in the right or left pulmonary artery, approx. 2cm from the hilum.
Incorrect position Too far down the pulmonary artery (known as a wedge position) or coiled up in the right ventricle.
Complications Pulmonary infarction and/or haemorrhage may occur if the catheter is left in the wedge position.
Naso-Gastric Tube
Purpose For dietary supplementation or gastric drainage.
Correct position Below the diaphragm within the stomach.
Incorrect position In the right (common) or left main bronchus or proximal oesophagus. If there is no trace of the NG tube on the film, it may be coiled at the back of the patient’s throat.
Complications If positioned in the right or left main bronchus, pulmonary infarction and/or haemorrhage may occur.
Endo-Tracheal Tube
Purpose To secure the airway and allow mechanical ventilation.
Correct position Between the clavicles and carina projected at the vertebral level T4-T5.
Incorrect position Most common misposition is down the right main bronchus.
Complications If directed down the right main bronchus, it is likely to cause collapse of the left lung.
Intra-Aortic Balloon Pump
Purpose To augment perfusion of the coronary arteries and to decrease the pressure against which the left ventricle pumps (known as after load).
Correct position The opaque marker should be in the proximal portion of the descending aorta, just distal to the subclavian artery.
Incorrect position A pressure monitor aids position, but there is very little room for error.
Complications The opaque marker indicates the proximal portion of the balloon. If it is too far down the descending aorta, the distal end of the balloon may obstruct the renal arteries and thereby impair blood flow to and kidneys, and therefore renal output.
Pigtail Catheter
Purpose To drain non-viscous fluid from the pleural space.
Correct position The tail of the catheter should ideally be within the collection of fluid it is intending to drain.
Incorrect position Abutting the mediastinum or other major structure.
Complication Although less likely to cause trauma than an IC drain, it is still possible to perforate a major structure on insertion or cause a pneumothorax on removal. |
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