Tubes, Catheters, Lines and Collection Devices
Endotracheal Tubes
Indications:
–Need mechanical ventilation or O2 delivery
–Inadequate arterial oxygenation
–Parenchymal diseases that impair gas exchange
–Upper-airway obstruction
–Impending gastric acid reflux or aspiration
–Tracheobronchial toilet (lavage)
A radiograph is needed to check tube placement and thereafter.
Tracheostomy - An operation performed under sterile technique that involves incising the skin over the trachea and then making a surgical wound in the trachea. A tube is placed in the opening in the trachea to provide an open airway and may sometimes be hooked to a ventilator. The tube is inserted directly into the trachea through the anterior surface of the neck.
A tracheostomy provides for an airway during upper-airway obstruction and is an emergency procedure only. Communication with tracheostomy patients is critical as their anxiety level is typically high. The technologist caring for the tracheostomy patient must also be sensitive to unmet and inexpressible needs and the need to keep the patient's anxiety level low. To minimize the possibility of infection, the technologist should not touch the tracheostomy area except under conditions of sterile technique. It is recommended that only properly trained personnel suction the tracheostomy patient.
Mechanical Ventilation - A machine that provides breathing through a tube passed through the mouth into the trachea and also may be attached to a tracheostomy.
Thoracostomy Tubes (Chest Tubes)
A chest tube can be used to re-inflate the lung.
Indications:
–Drain the intrapleural space and mediastinum
–To drain Fluid or air
–Creates negative pressure
–For Atelectasis
–For Pneumothorax
–For Hemothorax
–For Pleural effusion
–For Empyema
Common Insertion Sites - Insertion sites for thoracostomy vary with the intrapleural substances to be removed.
Usually inserted in 5th to 6th intercostal space, but can be as high as 4th intercostal space and as low as 8th.
Technologist Responsibilities
Images are performed to confirm chest tube position and chest status. Be careful to not catch tubing on x-ray equipment. The exterior assembly of the chest tubes must always remain lower than the patient's chest. You must use caution when moving and positioning the patient. You should report drainage in excess of 100 mL/hr and any change from a serous fluid to a darker red color.