Adobe Systems Devices on chest X-ray Tomáš Rohan, Radim Gerstberger, Monika Poláčková Diagnostické zobrazovací metody (aVLDI7X1c) Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Learning Outcomes ̶The student will become familiar with catheters and devices that can be described on a chest x-ray ̶ ̶The student will learn the correct position of the central venous catheter on a chest X-ray ̶ Adobe Systems ̶Central venous access (CVC, PICC, port catheters) ̶ ̶Pacemaker electrodes (PM, ICD) and other cardiovascular devices ̶ ̶Tracheal tube and tracheostomy ̶ ̶Nazogastric and nasoeneteric tubes Content of the lecture Diagnostické zobrazovací metody (aVLDI7X1c) Adobe Systems ̶Central venous access (CVC, PICC, port catheters) ̶ ̶Pacemaker electrodes (PM, ICD) and other cardiovascular devices ̶ ̶Tracheal tube and tracheostomy ̶ ̶Nazogastric and nasoeneteric tubes Diagnostické zobrazovací metody (aVLDI7X1c) Content of the lecture Adobe Systems PICC Port catheter CVC CVC, PICC, port catheters What to focus on? •Pneumothorax •Position of the tip •Course (kinked, twisted,...) •Integrity failure •Change over time on the control X-ray Diagnostické zobrazovací metody (aVLDI7X1c) Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Optimal position of CVC Adobe Systems carina tracheae Right atrium (RA) Superior vena cava Optimal position for CVC Cavoatrial junction (4cm below carina) Optimal position for PICC, port catheters 4cm Diagnostické zobrazovací metody (aVLDI7X1c) Mahlon, M.A.; Yoon, H.-C. CT Angiography of the Superior Vena Cava: Normative Values and Implications for Central Venous Catheter Position. J Vasc Interv Radiol 2007, 18, 1106–1110, doi:10.1016/j.jvir.2007.06.002. malpozice - špička katétru není v optimální poloze pro používání, tedy není v dist. třetině VCS, kavoatriálním ústí primární malpozice: ihned po implantaci, stočení do VJI, kontralaterální v. subclavia, proximální část VCS, stočení katétru v průběhu žíly sekundární malpozice (dislokace): povytažení, stočení do VJI, smyčka v cévě (při zvýšeném nitrohrudním tlaku-kašel, zvracení) malpozice je hlavní rizikový faktor pro rozvoj malfunkce (trombóza, mechanická obstrukce při naléhání špičky katétru na stěnu cévy) Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Complications of CVC •malposition (the tip of the catheter is not in optimal position – not in distal third of SVC or in cavoatrial junction) - primary - secondary •thrombosis, mechanical obstruction •arrhythmias ̶ Caers, J., Fontaine, C., Vinh-Hung, V. et al. Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports. Support Care Cancer 13, 325–331 (2005). https://doi.org/10.1007/s00520-004-0723-1 Adobe Systems Complications of CVC Diagnostické zobrazovací metody (aVLDI7X1c) Adobe Systems Complications of CVC Diagnostické zobrazovací metody (aVLDI7X1c) Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) 9cm Complications of CVC Adobe Systems CVC tip position ̶Is there a difference between upright and supine postibion? ̶Is there a difference between inspiration and expiration? ̶ NO YES 9mm Diagnostické zobrazovací metody (aVLDI7X1c) Pan, P.P.; Engstrom, B.I.; Lungren, M.P.; Seaman, D.M.; Lessne, M.L.; Kim, C.Y. Impact of Phase of Respiration on Central Venous Catheter Tip Position. J Vasc Access 2013, 14, 383–387, doi:10.5301/jva.5000135. Adobe Systems ̶Central venous access (CVC, PICC, port catheters) ̶ ̶Pacemaker electrodes (PM, ICD) and other cardiovascular devices ̶ ̶Tracheal tube and tracheostomy ̶ ̶Nazogastric and nasoeneteric tubes Diagnostické zobrazovací metody (aVLDI7X1c) Content of the lecture Adobe Systems Pacemaker electrodes ICD PM Diagnostické zobrazovací metody (aVLDI7X1c) What to focus on? •Pneumothorax •Position of the tip •Course (kinked, twisted,...) •Integrity failure •Change over time on the control X-ray ICD - implantable cardioverter defibrillator Adobe Systems RA electrode RA electrode RV electrode RV electrode Diagnostické zobrazovací metody (aVLDI7X1c) Correct position - pacemaker RA – right atrium RV – right ventricle Adobe Systems RA electrode RV electrode RA electrode Mv electrode Mv electrode RV electrode Diagnostické zobrazovací metody (aVLDI7X1c) Gutierrez, F.; Rossini, S.A.; Bhalla, S.; Cummings, K.; Capiel, C. Cardiac Pacemakers: What the Radiologist Needs to Know Available online: https://epos.myesr.org/poster/esr/ecr2010/C-0741 (accessed on 7 October 2021). Correct position - ICD Mv – marginal vein Adobe Systems Situs inversus Left superior vena cava (LSVC) Diagnostické zobrazovací metody (aVLDI7X1c) Gutierrez, F.; Rossini, S.A.; Bhalla, S.; Cummings, K.; Capiel, C. Cardiac Pacemakers: What the Radiologist Needs to Know Available online: https://epos.myesr.org/poster/esr/ecr2010/C-0741 (accessed on 7 October 2021). Variability of pacemaker/ICD electrodes LSCV - Left superior vena cava Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Other types of pacemakers/ICD Adobe Systems Temporary electrode for stimulation ICD with electrode in RV and azygos vein Subcutaneous ICD Leadless PM Epicardial pacing Diagnostické zobrazovací metody (aVLDI7X1c) Gutierrez, F.; Rossini, S.A.; Bhalla, S.; Cummings, K.; Capiel, C. Cardiac Pacemakers: What the Radiologist Needs to Know Available online: https://epos.myesr.org/poster/esr/ecr2010/C-0741 (accessed on 7 October 2021). Cardiovascular devices on Chest X-Ray, Radiology Assistant. Available online: https://radiologyassistant.nl/cardiovascular/devices/cardiovascular-devices (accessed on 7 October 2021). AV – azygos vein Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Complications of pacemaker/ICD electrodes Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Dislocation Immediately after implantation 1 month after implantation Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Gutierrez, F.; Rossini, S.A.; Bhalla, S.; Cummings, K.; Capiel, C. Cardiac Pacemakers: What the Radiologist Needs to Know Available online: https://epos.myesr.org/poster/esr/ecr2010/C-0741 (accessed on 7 October 2021). Cardiovascular devices on Chest X-Ray, Radiology Assistant. Available online: https://radiologyassistant.nl/cardiovascular/devices/cardiovascular-devices (accessed on 7 October 2021). Fracture of electrodes V anamn. Záškuby bránice Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Gutierrez, F.; Rossini, S.A.; Bhalla, S.; Cummings, K.; Capiel, C. Cardiac Pacemakers: What the Radiologist Needs to Know Available online: https://epos.myesr.org/poster/esr/ecr2010/C-0741 (accessed on 7 October 2021). Cardiovascular devices on Chest X-Ray, Radiology Assistant. Available online: https://radiologyassistant.nl/cardiovascular/devices/cardiovascular-devices (accessed on 7 October 2021). Perforation of right ventricle V anamn. Záškuby bránice Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Prosthetic heart valves Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Cardiovascular devices on Chest X-Ray, Radiology Assistant. Available online: https://radiologyassistant.nl/cardiovascular/devices/cardiovascular-devices (accessed on 7 October 2021). Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Other cardiovascular devices on X-ray Adobe Systems Mitral clip ILR (implantable loop recorder) Occluder Atriclip Coronary stent Vascular stent Diagnostické zobrazovací metody (aVLDI7X1c) Cardiovascular devices on Chest X-Ray, Radiology Assistant. Available online: https://radiologyassistant.nl/cardiovascular/devices/cardiovascular-devices (accessed on 7 October 2021). Intra-Aortic Balloon Counterpulsation Adobe Systems ̶Central venous access (CVC, PICC, port catheters) ̶ ̶Pacemaker electrodes (PM, ICD) and other cardiovascular devices ̶ ̶Tracheal tube and tracheostomy ̶ ̶Nazogastric and nasoeneteric tubes Diagnostické zobrazovací metody (aVLDI7X1c) Content of the lecture Adobe Systems Tracheal tube Tracheostomy Diagnostické zobrazovací metody (aVLDI7X1c) Correct position Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Tracheal tube - malposition Adobe Systems ̶Central venous access (CVC, PICC, port catheters) ̶ ̶Pacemaker electrodes (PM, ICD) and other cardiovascular devices ̶ ̶Tracheal tube and tracheostomy ̶ ̶Nazogastric and nasoeneteric tubes Diagnostické zobrazovací metody (aVLDI7X1c) Content of the lecture Adobe Systems Nazogastric and nazojejunal tube – correct position Diagnostické zobrazovací metody (aVLDI7X1c) Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Nasogastric or nasojejunal tubes - malposition Adobe Systems Diagnostické zobrazovací metody (aVLDI7X1c) Adobe Systems Take home message ̶ ̶The importance of X-ray in assessing the position and complications of catheters and tubes ̶ ̶Optimal position of central venous catheters ̶ ̶ Diagnostické zobrazovací metody (aVLDI7X1c) Lékařská fakulta Masarykovy univerzity 2021 Adobe Systems