{"cells":[{"metadata":{},"cell_type":"markdown","source":"# This Notebook mainly focus on pictorial explanation of Radiographic Assessment of Tubes, Lines - Normal Placement, Positioning Errors for Radiological Evaluation"},{"metadata":{},"cell_type":"markdown","source":"# Do remember to upvote if you like the content :)"},{"metadata":{"trusted":true},"cell_type":"code","source":"import os\nfrom IPython.display import Image","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# Endotracheal Tubes (ETT) – Normal Position\n\n\n1. Gold standard for determining placement in airway is end-tidal CO2\n\n* Limited ability to detect some complications\n\n* Physical exam maneuvers also may be helpful\n\n2. Radiographic assessment of tube position based on visualizing radioopaque line on ETT\n\n3. ETT position dependent on neck flexion and extension:\n   * Neck flexion (mandible @ T1-2): ETT tip can descend up to 2 cm\n   * Neck extension (mandible @ C4): ETT tip can ascend up to 2 cm\n   \n4. Acceptable positioning:\n  * Proximal tube tip: level of medial heads of the clavicle\n  * Too proximal – risk upper airway/vocal cord injury\n  * Distal tube tip: 2 cm above carina\n  * Too distal – mainstem bronchus intubation with neck flexion\n  * Tracheal cuff should fill tracheal wall (not bulge)\n"},{"metadata":{},"cell_type":"markdown","source":"# Endotracheal Tubes – Normal Position\n\n\n"},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/ET-NP.PNG\")","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# Endotracheal Tubes – Abnormal Position\n\n1. Potential Complications:\n   * Increased risk of spontaneous\n   * extubation\n   * Aspiration\n   * Vocal cord injury\n   * Gastric distension\n   * Left lobe (R main stem bronchus) or right upper lobe (R inferior intermediate bronchus) collapse/atelectasis\n   * Tension pneumothorax"},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/et-ab1.PNG\")","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# Endotracheal Tubes – Complications"},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/et-ab2.PNG\")","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# Tracheostomy Tubes – Normal Position\n\n1. Similar distal tip positioning rules as ETTs\n\n2. Tip position should NOT vary with neck flexion/extension\n\n3. At least 2/3 of “smooth” portion should lie within the trachea"},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/tt-np.PNG\")","execution_count":null,"outputs":[]},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/tt-np1.PNG\")","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# Tracheostomy Tubes – Complications\n\nPotential complications\n* Tracheal injury\n    * Subcutaneous emphysema/pneumomediastinum\n* Pneumothorax\n* Hemorrhage\n* Late complications:\n    * Tracheal stenosis\n    * Tracheomalacia\n    * Vascular erosions\n    * Tracheobronchial fistula"},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/ttc.PNG\")","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# Central Venous Catheters – Normal Position\n\n\n1. Central venous catheter may be central (IJ, subclavian) or peripheral (PICC)\n\n2. Catheter tip should terminate in SVC or cavo-atrial junction\n  * “OK to use” varies with intended function\n\n3. Placement borders:\n  * Brachiocephalic/IJ junction – 1st anterior intercostal space\n    * Last venous valve\n  * Cavo-atrial junction – inferior border of right bronchus intermedius (+2.5 cm below)\n    * Prevent cardiac chamber insertion"},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/cv-np.PNG\")","execution_count":null,"outputs":[]},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/cv-np2.PNG\")","execution_count":null,"outputs":[]},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/cv-np1.PNG\")","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# Central Venous Catheters – Abnormal Position\n\n\nPositioning errors:\n\n* Ipsilateral IJ\n* Contralateral brachiocephalic vein\n* Right atrium/ventricle\n  * Increased risk of arrhythmias\n  * Reduced dilution of administered medications\n* Azygous vein*\n* Internal thoracic vein*"},{"metadata":{"trusted":true},"cell_type":"code","source":"Image(filename=\"../input/images/cv-ab.PNG\")","execution_count":null,"outputs":[]},{"metadata":{},"cell_type":"markdown","source":"# For an indepth domain understanding go to this Notebobook - https://www.kaggle.com/prvnkmr/walk-down-of-domain-understanding"},{"metadata":{"trusted":true},"cell_type":"code","source":"","execution_count":null,"outputs":[]}],"metadata":{"kernelspec":{"language":"python","display_name":"Python 3","name":"python3"},"language_info":{"pygments_lexer":"ipython3","nbconvert_exporter":"python","version":"3.6.4","file_extension":".py","codemirror_mode":{"name":"ipython","version":3},"name":"python","mimetype":"text/x-python"}},"nbformat":4,"nbformat_minor":4}