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Lost In Space: Lines and Tubes in the Wrong Places

Lost In Space: Lines and Tubes in the Wrong Places. Katrina Acosta, M.D. June 30, 2005. Objectives:. Review normal position of central venous catheters Review normal position of pulmonary artery catheters Review normal position of endotracheal tubes

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Lost In Space: Lines and Tubes in the Wrong Places

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  1. Lost In Space: Lines and Tubes in the Wrong Places Katrina Acosta, M.D. June 30, 2005

  2. Objectives: • Review normal position of central venous catheters • Review normal position of pulmonary artery catheters • Review normal position of endotracheal tubes • Review normal position of nasogastric and feeding tubes

  3. Acute Complications • Malposition • Vessel Perforation • Arterial puncture/ cannulation • Air embolus • Pneumothorax • Spasm

  4. Postplacement right subclavian catheter chest radiograph.

  5. Patient decompensated, requiring intubation.

  6. Post placement right subclavian vein dual-lumen chest port radiograph.

  7. Acute Complications • Malposition • Vessel Perforation • Arterial puncture/ cannulation • Air embolus • Pneumothorax • Spasm

  8. Postprocedural radiograph after right subclavian line placement.

  9. Acute Complications • Malposition • Vessel Perforation • Arterial puncture/ cannulation • Air embolus • Pneumothorax • Spasm

  10. CT performed after patient presented with agitation, shortness of breath, hypotension.

  11. Complication: air embolus

  12. Acute Complications • Malposition • Vessel Perforation • Arterial puncture/ cannulation • Air embolus • Pneumothorax • Spasm

  13. Postplacement right subclavian catheter chest radiograph.

  14. 10 hours after the placement of a right subclavian line. Now, the patient feels sick. She has dyspnea, tachypnea, tachycardia and a low blood pressure.

  15. Chest Tube • The pleural space may fill with air (pneumothorax), fluid (pleural effusion), blood (hemothorax) and pus (empyema). • If pneumothorax >20%, air may be evacuated by thoracentesis or by insertion of a chest tube attached to an underwater seal. Goal to reestablish the subatmospheric intrapleural pressure which will re-expand the lung.

  16. Postplacement chest tube radiograph.

  17. Postplacement chest tube radiograph with hemorrhagic fluid output.

  18. COMPLICATIONS:CHRONIC Non-function Catheter fragmentation Infection

  19. Poor flow and drawback.

  20. Decreased flow rates during dialysis.

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