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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 aboard 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 thrombosed 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 tends to be
tend to be the ones that thrombosed 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 two
centimeters away from the hilum and
complications include pulmonary
infarction 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 usually placed and rose
superiorly
for the pneumothorax which tends to rise
superior because of gravity for
effusions they're usually placed
postural inferiorly 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 inferior Lee
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 pacemakers 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 in the right atrium and
one within the coronary sinus and these
are usually paste placed by
cardiologists and they determine which
of these would work best for the patient
so this is an example of a patient with
a pacemaker you can see the pacemaker
battery here overlying the left Hemi
thorax likely 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 a couple of round
densities within the heart you see them
pretty well on 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 and/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 this include
occlusion of the great vessels if it's
placed to approximately it could also
cost 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 a 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 want to make sure that they
all look like they're in good position
you want to 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
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you