Presentation
Post surgery for cardiac tamponade, to assess the position of lines and tubes.
Patient Data
Age: 55 years
Gender: Female
From the case:
Suboptimally placed lines and tubes on chest x-ray
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Lines and tubes:
- The end of the endotracheal tube is projected around 1 cm above the carina. This should be retracted approximately 3 cm.
- The nasogastric tube is seen curling back in the mid esophagus and proceeding superiorly, with the tip and side hole not visualized. This should be replaced.
- The left internal jugular central venous catheter is seen to curl back with its tip projected superiorly in the internal jugular vein. This should be replaced.
- There are two appropriately positioned chest drains projected in the anterior and superior mediastinum.
Other findings:
- The prosthetic heart valve ring and surgical clips are noted.
Case Discussion
The optimal position for an endotracheal tube is with the tip 3-7 cm above the carina.
The optimal position for a nasogastric tube is with the tip (and side hole) in the stomach well below the diaphragm, at least 10 cm beyond the gastro-esophageal junction.
The optimal position for an internal jugular central venous catheter is with the tip in the superior vena cava or at the superior cavo-atrial junction.