So another type of line is called a peripherally inserted central catheter or a PICC line.
This provides long term venous access for medication administration
or blood draws but it's a smaller bore than a central line.
It's usually placed into the cephalic, basilic or brachial veins
within the arm and the tip is advanced until it reaches the SVC.
These lines may thrombose because they have a very small lumen size,
so that's important to keep in mind when you think about
how long the patient will need the line in place.
The lines that are placed for a longer period of time tend to be the one that thrombose.
So a Swan-Ganz Catheter monitors pulmonary artery and right heart pressure.
It's placed into the subclavian or IJ veins just like a central line is
and the tip is advanced to the proximal or left, proximal right or left pulmonary artery.
It should be approximately 2 cm away from the hilum
and complications include pulmonary infraction
from occlusion of the pulmonary artery by catheter.
It's not a very common complication but something to keep in mind.
So you can see here, the Swan-Ganz Catheter coming and then looping around
ending in the expected location within the left pulmonary artery.
Chest tubes are placed to drain collections of air or fluid within the pleural space.
This is very commonly seen in patients that have a pneumothorax
and they're a usually placed anterosuperiorly for the pneumothorax
which tends to rise superior because of gravity.
For effusions they're usually placed posteroinferiorly
because the fluid again because of gravity drifts down to the bottom of the lung.
Chest tubes have side holes which should remain within the thoracic cavity
because if the side holes are out within the soft tissues,
it can result in subcutaneous emphysema.
Complications of a chest tube include laceration of the intercostal artery
which can cause bleeding, they can also cause laceration of the liver or spleen
if they're placed too far inferiorly.
So let's talk a little bit about cardiac devices,
this is an example of a pacemaker which is placed to regulate heart rhythm.
The generator is usually implanted subcutaneously within the chest wall.
So there can be different types of pacemaker,
you can have a single lead pacemaker
which has a single lead that's positioned in the apex of the right ventricle.
You can have a dual lead pacemaker which has one lead within the apex
of the right ventricle and another within the right atrium.
Or you can have a triple lead pacemaker
which has one lead in the apex of the right ventricle,
one on the right atrium and one within the coronary sinus.
And these are usually paced placed by cardiologists
and they determine which of these would work best for the patient.
So this is an example of a patient with the pacemaker,
you can see the pacemaker battery, here,
overlying the left hemithorax slightly embedded within the soft tissues here
and then you can see the leads coming down here.
This is an example of what it would look like on the lateral view,
you can see two leads coming down here on the lateral view.
This patient also has something else within the heart.
So do you know what that is?
There are couple of round densities within the heart,
you see them pretty well in the lateral view here.
So these are actually valve replacements and these are occasionally seen in patients as well.
So let's talk a little bit about a defibrillator and how it looks different from a pacemaker.
So defibrillators are used in the setting of a tachyarrhythmia.
You have one electrode within the SVC or brachiocephalic vein
and possibly a second at the right ventricular apex.
The leads may fracture so this is important to look for
when you're taking a look at the imaging of a defibrillator.
And you can see that the distal tip of the defibrillator
is actually thicker than that of a pacemaker
and that's really how you differentiate between the two.
So what is an intra-aortic balloon pump?
It's actually a type of line that's placed that increases cardiac output
and coronary artery flow. This is usually placed in the proximal descending aorta,
distal to the left subclavian and the balloon inflates during diastole
and deflates during systole. You only see a very small portion of it on a radiograph
and this is what it looks like right here.
We don't actually see the balloon part but really just the part that's metallic.
Complications of these include occlusion of the great vessels if it's placed too proximally.
It could also cause showering of emboli during either placement or removal.
And it can occasionally cause aortic dissection or perforation.
Again, these are not very common complications but something to be aware of.
So we've gone over multiple different lines and tubes that can be found within a patient,
usually when I take a look at the chest x-ray.
I start off by taking at the lines, taking a look at the lines and tubes kind of early on
because you wanna make sure that they all look like that they're in good position,
you wanna make sure that none of them are broken
before you go on to taking a look at the rest of the film
including the lungs and the mediastinum.