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Published byDominick Walters Modified over 8 years ago
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Lost In Space: Lines and Tubes in the Wrong Places Katrina Acosta, M.D. June 30, 2005
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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
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Acute Complications Malposition Vessel Perforation Arterial puncture/ cannulation Air embolus PneumothoraxSpasm
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Postplacement right subclavian catheter chest radiograph.
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Patient decompensated, requiring intubation.
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Post placement right subclavian vein dual-lumen chest port radiograph.
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Acute Complications Malposition Vessel Perforation Arterial puncture/ cannulation Air embolus PneumothoraxSpasm
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Postprocedural radiograph after right subclavian line placement.
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Acute Complications Malposition Vessel Perforation Arterial puncture/ cannulation Air embolus PneumothoraxSpasm
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CT performed after patient presented with agitation, shortness of breath, hypotension.
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Complication: air embolus
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Acute Complications Malposition Vessel Perforation Arterial puncture/ cannulation Air embolus PneumothoraxSpasm
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Postplacement right subclavian catheter chest radiograph.
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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.
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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.
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Postplacement chest tube radiograph.
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Postplacement chest tube radiograph with hemorrhagic fluid output.
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COMPLICATIONS: CHRONIC Non-function Catheter fragmentation Infection
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Poor flow and drawback.
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Decreased flow rates during dialysis.
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