Clinical Case Database / Category: Clinical Care
Tubes and lines in radiographs
Publication details
Dr Leena S Naidu, MBBS, MRCP (UK), FRCR, Dr Rajesh Botchu, MBBS, MRCSEd, MRCSI, MS (Orth), FRCR
Foundation Years Journal, volume 8, issue 1, p.88 (123Doc Education, London, January 2014)
Abstract
Plain radiography is integral in the examination of ill patients particularly nursed in intensive care and high dependency units. Evaluation of placement of tubes and lines is critical to ensure patient safety before administration of treatment. Immediate help from radiologists will not be always be available, hence junior doctors should be competent to evaluate these radiographs for this crucial information. The purpose of this pictorial review is to discuss the expected range of normal position of the commonly used devices and illustrate their abnormal placement. For the purpose of simplicity, we will be discussing central venous catheters; endotracheal tube and nasogastric tube which constitute the most commonly placed tubes and lines in acute setting.
Other tubes like pulmonary artery (swan-ganz) catheters, intra-aortic balloon pumps, umbilical artery/vein lines, pacing wires will not be covered in this article.
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Authors
Dr Leena S Naidu, MBBS, MRCP (UK), FRCR (Corresponding author)
Consultant Radiologist
Kettering General Hospital Foundation Trust
Rothwell Road
Kettering
NN16 8UZ
Dr Rajesh Botchu, MBBS, MRCSEd, MRCSI, MS (Orth), FRCR (Corresponding author)
Consultant Radiologist
Kettering General Hospital Foundation Trust
Rothwell Road
Kettering
NN16 8UZ
References
1. Batra P. Radiology of Monitoring Devices. In Syllabus for Thoracic Imaging 2001, the annual meeting of the Society of Thoracic Radiology; 202-4.
2. Trotman-Dichenson B. Radiography in the Critical Care Patient. In McCloud TC, editor: Thoracic Radiology: the Requisites, St. Louis, 1992; 151-172.
3. Vesely, T. "Central Venous Catheter Tip Position: A Continuing Controversy" Journal of Vascular and Interventional Radiology, Volume 14(5) May 2003, pp 527-534.
4. Fletcher S, Bodenham AR. "Safe placement of central venous catheters: where should the tip of the catheter lie?" British Journal of Anaesthesia 2000; 85: 188–91.
5. McGillicuddy DC, Babineau MR, Fisher J, Ban K, Sanchez LD. Is a postintubation chest radiograph necessary in emergency department? Int J Emerg Med 2009; 2:247-249.
6. Stonelake PA, Bodenham AR. The carina as a radiological landmark for central venous catheter tip position British journal of Anaesthesia 2006; 96:335-340.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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