Suboptimally placed lines and tubes on chest x-ray
Post surgery for cardiac tamponade, to assess the position of lines and tubes.
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Lines and tubes:
- The end of the endotracheal tube is projected around 1cm 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.
The prosthetic heart valve ring and surgical clips are noted.
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 cavo-atrial junction.