{"cells":[{"metadata":{},"cell_type":"markdown","source":"# I have a habit of going throughly through the problem domain before attempting the problem at hand. In this notebook is all the knowledge that I gathered."},{"metadata":{},"cell_type":"markdown","source":"# As always please **upvote** if you like the content :)"},{"metadata":{},"cell_type":"markdown","source":"# Overview"},{"metadata":{},"cell_type":"markdown","source":"In very simple words, our task here is to determine whether the positioned lines and tubes in patients are optimally placed or not. \nThat is because hospital patients can have serious complications (even death) if they are positioned incorrectly."},{"metadata":{},"cell_type":"markdown","source":"# Devices, their Uses and Complications"},{"metadata":{},"cell_type":"markdown","source":"# What is Endotracheal Tube and Its purpose?\n\nAn endotracheal tube is a flexible plastic tube that is placed through the mouth into the trachea (windpipe) to help a patient breathe. The endotracheal tube is then connected to a ventilator, which delivers oxygen to the lungs. The process of inserting the tube is called endotracheal intubation.\n\nThere are many reasons why an endotracheal tube may be placed, including surgery with a general anesthetic, trauma, or serious illness. Learn about the procedure, potential risks and complications, and what you might expect.\n\nAn endotracheal tube is placed when a patient is unable to breathe on their own, when it is necessary to sedate and \"rest\" someone who is very ill, or to protect the airway. The tube maintains the airway so that air can pass into and out of the lungs."},{"metadata":{},"cell_type":"markdown","source":"![](https://images-na.ssl-images-amazon.com/images/I/311qXuPEwCL._SX466_.jpg)\n\n![](https://study.com/cimages/videopreview/hc5i2duin3.jpg)"},{"metadata":{},"cell_type":"markdown","source":"# Uses of Endotracheal Tube\n\n\nThere are a number of indications for placement of an endotracheal tube that can be broken down into a few broad categories. These include:\n\n**General surgery**: With general anesthesia, the muscles of the body including the diaphragm are paralyzed, and placing an endotracheal tube allows the ventilator to do the work of breathing.\n\n**Foreign body removal**: If the trachea is obstructed by a foreign body that is aspirated (breathed in), an endotracheal tube may be placed to help with the removal of the foreign object.\n\n**To protect the airway against aspiration**: If someone has a massive gastrointestinal bleed (bleeding in the esophagus, stomach, or upper intestine) or suffers a stroke, an endotracheal tube may be placed to help prevent the stomach contents from entering the airways.\n\nIf the stomach contents are accidentally breathed in, a person may develop aspiration pneumonia, a very serious and potentially life-threatening disease.\n\n**To visualize the airway**: If an abnormality of the larynx, trachea, or bronchi is suspected, such as a tumor or a congenital malformation (birth defect), an endotracheal tube may be placed to allow careful visualization of the airways.\n\n**After surgery**: After surgery on the chest such as lung cancer surgery or heart surgery, an endotracheal tube connected to a ventilator may be left in place to help with breathing after surgery. In this case, a person may be \"weaned\" from the ventilator at some time during recovery.\n\n**To support breathing**: If someone is having difficulty breathing due to pneumonia, a pneumothorax (collapse of a lung), respiratory failure or impending respiratory failure, heart failure, or unconsciousness due to an overdose, stroke, or brain injury, an endotracheal tube may be placed to support breathing.\n\nSome medical conditions (especially neurological conditions) can result in full or partial paralysis of the diaphragm and may require respiratory support. Examples include amyotrophic lateral sclerosis, Guillain-Barre syndrome, and botulism.1\n\nThe diaphragm may also become paralyzed due to damage or pressure on the phrenic nerve related to trauma or a tumor in the chest.\n\n**When sedation is required**: If strong sedatives are needed, such as when a person is very ill, an endotracheal tube may be placed to assist with breathing until the sedatives can be discontinued.\n\n**In premature babies**: Respiratory distress in premature babies often requires placement of an endotracheal tube and mechanical ventilation.\n\n**When a higher concentration of oxygen is needed**: Endotracheal tube placement and mechanical ventilation allows for the delivery of higher concentrations of oxygen than found in room air."},{"metadata":{},"cell_type":"markdown","source":"# Complications and Risks\n\nThere are both **short-term and long-term risks** and complications associated with endotracheal tube placement. Short-term complications may include:\n\n* Bleeding\n* Esophageal placement of the tube: One of the most serious complications is improper placement of the endotracheal tube into the esophagus. If this goes unnoticed, the lack of oxygen to the body could result in brain damage, cardiac arrest, or death.\n* Temporary hoarseness when the tube is removed\n* Injury to the mouth, teeth or dental structures, tongue, thyroid gland, voice box (larynx), vocal cords, windpipe (trachea), or esophagus. Dental injuries (particularly to the upper incisors) occur in around one in 3000 intubations.\n* Infection\n* Pneumothorax (collapse of a lung): If the endotracheal tube is advanced too far such that it only enters one bronchus (and thus ventilates only one lung), inadequate ventilation may occur or collapse of one lung.\n\n* Aspiration of contents of the mouth or stomach during placement which can, in turn, result in aspiration pneumonia\n\n* Persistent need for ventilatory support (see below)\n\n* Atelectasis: Inadequate ventilation (a respiratory rate that is too low) can result in collapse of the smallest of airways, the alveoli resulting in atelectasis (partial or complete collapse of a lung).\n\n**Long term complications** that may persist or arise later on may include:\n\n* Tracheal stenosis, or narrowing of the trachea: Most common in people who require prolonged intubation, and once occurring in around 1% of people who were intubated\n* Tracheomalacia\n* Spinal cord injuries\n* Tracheoesophageal fistula (an abnormal passageway between the trachea and esophagus)\n* Vocal cord paralysis: A rare complication that can cause permanent hoarsenes"},{"metadata":{},"cell_type":"markdown","source":"# What is Tracheostomy Tubes\n\nA tracheostomy (trach) tube is a curved tube that is inserted into a tracheostomy stoma (the hole made in the neck and windpipe (Trachea)). There are different types of tracheostomy tubes that vary in certain features for different purposes.  These are manufactured by different companies.  However, a specific type of tracheostomy tube will be the same no matter which company manufactures them.\n\nA commonly used tracheostomy tube consists of three parts: outer cannula with flange (neck plate), inner cannula, and an obturator. The outer cannula is the outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or velcro strap around the neck. The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube.  It fits inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted."},{"metadata":{},"cell_type":"markdown","source":"![](https://www.stgeorges.nhs.uk/wp-content/uploads/2013/08/trach1.jpg)\n\n\n![](https://www.childrens.health.qld.gov.au/wp-content/uploads/images/fact-sheets/tracheostomy-tubes.png)"},{"metadata":{},"cell_type":"markdown","source":"# Complications and Risks of Tracheostomy\n\nAs with any surgery, there are some risks associated with tracheotomies. However, serious infections are rare.\n\n\nEarly Complications that may arise during the tracheostomy procedure or soon thereafter include:\n\n* Bleeding\n* Air trapped around the lungs (pneumothorax)\n* Air trapped in the deeper layers of the chest(pneumomediastinum)\n* Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema)\n* Damage to the swallowing tube (esophagus)\n* Injury to the nerve that moves the vocal cords (recurrent laryngeal nerve)\n* Tracheostomy tube can be blocked by blood clots, mucus or pressure of the airway walls.  Blockages can be prevented by suctioning, humidifying the air, and selecting the appropriate tracheostomy tube.\n\n\nLater Complications that may occur while the tracheostomy tube is in place include:\n\n* Accidental removal of the tracheostomy tube (accidental decannulation)\n* Infection in the trachea and around the tracheostomy tube\n* Windpipe itself may become damaged for a number of reasons, including pressure from the tube; bacteria that cause infections and form scar tissue; or friction from a tube that moves too much\n"},{"metadata":{},"cell_type":"markdown","source":"# Central Venous Catheter (CVC)\n\nA central venous catheter (CVC), also known as a central line, central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous therapies, for more reliable vascular access. These catheters are commonly placed in veins in the neck (internal jugular vein), chest (subclavian vein or axillary vein), groin (femoral vein), or through veins in the arms (also known as a PICC line, or peripherally inserted central catheters).\n\nCentral lines are used to administer medication or fluids that are unable to be taken by mouth or would harm a smaller peripheral vein, obtain blood tests (specifically the \"central venous oxygen saturation\"), administer fluid or blood products for large volume resuscitation, and measure central venous pressure. The catheters used are commonly 15–30 cm in length, made of silicone or polyurethane, and have single or multiple lumens for infusion."},{"metadata":{},"cell_type":"markdown","source":"![](https://2.bp.blogspot.com/-DWqTC7UN6TI/W68_j2cL3fI/AAAAAAAAB_o/5xIvWDAfQ10sHRSfYYCIb8e16m7SF-ZEQCLcBGAs/w1200-h630-p-k-no-nu/Central%2Bvenous%2Bcatheter.jpg)"},{"metadata":{},"cell_type":"markdown","source":"# Medical Uses\n\nThe following are the major indications for the use of central venous catheters\n\n* Difficult peripheral venous access – central venous catheters may be placed when it is difficult to gain or maintain venous access peripherally (e.g. obesity, scarred veins from prior cannulations, agitated patient).\n\n* Delivery of certain medications or fluids – medications such as vasopressors (e.g., norepinephrine, vasopressin, phenylephrine etc.), chemotherapeutic agents, or hypertonic solutions are damaging to peripheral veins and often require placement of a central line. Additionally, catheters with multiple lumens can facilitate the delivery of several parenteral medications simultaneously.\n\n* Prolonged intravenous therapies – parenteral medications that must be delivered for extended periods of time (more than a few days) such as long-term parenteral nutrition, or intravenous antibiotics are administered through a central line.\n\n* Specialized treatment – interventions such as hemodialysis, plasmapheresis, transvenous cardiac pacing, and invasive hemodynamic monitoring (e.g. pulmonary artery catheterization) require central venous access.\n"},{"metadata":{},"cell_type":"markdown","source":"# Complications if not properly inserted\n\nCentral line insertion may cause several complications. The benefit expected from their use should outweigh the risk of those complications.\n\n**Pneumothorax**\n\nThe incidence of pneumothorax is highest with subclavian vein catheterization due to its anatomic proximity to the apex of the lung. In the case of catheterization of the internal jugular vein, the risk of pneumothorax is minimized by the use of ultrasound guidance. For experienced clinicians, the incidence of pneumothorax is about 1.5–3.1%. The National Institute for Health and Clinical Excellence (UK) and other medical organizations recommend the routine use of ultrasonography to minimize complications.\n\nIf a pneumothorax is suspected, an upright chest x-ray should be obtained. An upright chest x-ray is preferred because free air will migrate to the apex of the lung, where it is easily visualized. Of course, this is not always possible, particularly in critically ill patients in the intensive care unit. Radiographs obtained in the supine position fail to detect 25–50% of pneumothoraces. Instead, bedside ultrasound is a superior method of detection in those too ill to obtain upright imaging.\n\n**Vascular perforation**\n\nPerforation of vasculature by a catheter is a feared and potentially life-threatening complication of central lines. Fortunately, the incidence of these events is exceedingly rare, especially when lines are placed with ultrasound guidance. Accidental cannulation of the carotid artery is a potential complication of placing a central line in the internal jugular vein. This occurs at a rate of approximately 1% when ultrasound guidance is used. However, it has a reported incidence of 0.5–11% when an anatomical approach is used. If the carotid is accidentally cannulated and a catheter is inserted into the artery, the catheter should be left in place and a vascular surgeon should be notified because removing it can be fatal.\n\n**Catheter-related bloodstream infections**\n\nAll catheters can introduce bacteria into the bloodstream. This can result in serious infections that can be fatal in up to 25% of cases. The problem of central line-associated bloodstream infections (CLABSI) has gained increasing attention in recent years. They cause a great deal of morbidity (harm) and deaths, and increase health care costs.\n\nMicrobes can gain access to the bloodstream via a central catheter a number of ways. Rarely, they are introduced by contaminated infusions. They might also gain access to the lumen of the catheter through break points such as hubs. However, the method by which most organisms gain access is by migrating along the portion of the catheter tracking through subcutaneous tissue until they reach the portion of the catheter in the vein. Additionally, bacteria present in the blood may attach to the surface of the catheter, transforming it into a focus of infection.\n\n**Misplacement**\n\nCVC misplacement is more common when the anatomy of the person is different or difficult due to injury or past surgery.\n\nCVCs can be mistakenly placed in an artery during insertion (for example, the carotid artery or vertebral artery when placed in the neck or common femoral artery when placed in the groin). This error can be quickly identified by special tubing that can show the pressure of the catheter (arteries have a higher pressure than veins). In addition, sending blood samples for acidity, oxygen, and carbon dioxide content (pH, pO2, pCO2 respectively) can show the characteristics of an artery (higher pH/pO2, lower pCO2) or vein (lower pH/pO2, higher pCO2).\n\nDuring subclavian vein central line placement, the catheter can be accidentally pushed into the internal jugular vein on the same side instead of the superior vena cava. A chest x-ray is performed after insertion to rule out this possibility. The tip of the catheter can also be misdirected into the contralateral (opposite side) subclavian vein in the neck, rather than into the superior vena cava."},{"metadata":{},"cell_type":"markdown","source":"# Wrap Up\n\nNow that we have much closer understanding of what are all the **equipments**, **what they do** and why is is important to **properly insert them**, we go ahead with developing the solutions required to do so."},{"metadata":{},"cell_type":"markdown","source":"# Do checkout the following notebook if you want to get a pictorial explanation of the problem\n\nhttps://www.kaggle.com/prvnkmr/radiographic-assessment-of-tubes-and-lines#Central-Venous-Catheters-%E2%80%93-Normal-Position"},{"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}