Lines and tubes (radiograph)

Lines and tubes are important components in chest radiographic evaluation.

Nasogastric tube (NGT)

See: nasogastric tube positioning. 

Correct position

• NG tube tip ≥10 cm distal to the gastro-esophageal junction
  • i.e. below the left hemidiaphragm

Complications

• insertion into trachea or bronchus (pneumonia/pulmonary contusion/pulmonary laceration)
• pharyngeal or esophageal perforation

Nasopharyngeal airway tube (NPAT)

See: nasopharyngeal airway tube

Correct position

• Tip immediately above the epiglottis

Complications

• risk of intracranial positioning in patients with basal skull fracture

Endotracheal tube (ETT)

See: evaluation of endotracheal tube position.

Correct position

• ETT tip 5 cm +/- 2 cm above carina
  • i.e. at level of medial ends of clavicles

Complications

• selective intubation (contralateral lung collapse/hyperinflation of ipsilateral lung/pneumothorax)
• tooth aspiration

Central venous line/catheter (CVL/CVC)

Correct position

• CV line tip in the superior vena cava or at the superior cavoatrial junction
  • i.e. at level of 1^st anterior intercostal space above the carina

Complications

• insertion into right atrium or ventricle (non-bacterial thrombotic endocarditis / dysrhythmias / myocardial perforation)
• mediastinal hematoma secondary to vessel perforation
• pneumothorax
• hemothorax
• central line-associated bloodstream infection
• deep venous thrombosis
• line fracture +/- embolization

Intercostal tube/catheter (ICC)

See: intercostal catheter

Correct position

• intercostal tube tip lies between visceral and parietal pleura
  • anterosuperiorly to drain pneumothorax
  • posteroinferiorly to drain pleural effusion or hemothorax

Complications

• placement into lung parenchyma, interlobar fissure or subcutaneous tissue
• mediastinal or abdominal visceral trauma
• re-expansion pulmonary edema

Permanent pacemaker (PPM)

Correct position

• single chamber: electrode tip in right atrial appendage (atrial pacing) or right ventricular apex (ventricular pacing)
• dual chamber: electrode tips in right atrium and right ventricular apex
• biventricular: electrode tips in right atrium, right ventricle and coronary sinus
• implantable converter defibrillator: electrode tip in apex of right ventricle

Complications

• lead malposition (dysrhythmias)
• pneumothorax
• myocardial perforation
• lead fracture

Temperature probe

See: temperature probe

Correct position

• in the upper to mid thoracic esophagus

Complications

• placement into trachea or bronchus
• pneumomediastinum
• pneumothorax

Pericardial drain

Correct position

• usually inserted on the left of midline into the pericardial space

Intra-aortic balloon pump (IABP)

See: intra-aortic balloon pump

Correct position

• tip at the level of the AP window

Complications

• aortic dissection
• obstruction of the left subclavian artery (too high)
• obstruction of the splanchnic arteries (too low)