11 - Paediatric Chest Imaging

11 - Paediatric Chest Imaging - PaediatricChestImaging The...

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    Paediatric Chest Imaging
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The initial assessment of the paediatric CXR should include: 1) Technique of the exam, to include patient positioning, proper exposure and the degree of inspiration 2) Position of all tubes and lines and evaluation for pneumothorax, pneumomediastinum, and pneumoperitoneum 3) Mediastinal and cardiac silhouettes 4) Airway and lungs 5) Pulmonary vascular pattern 6) Abdomen
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Inspiratory                     Expiratory 
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    Chest Tubes and Catheters. 
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An essential part of the assessment of the neonatal chest x-ray includes identification of the position of the various tubes. Endotracheal tubes (ETT). Nasogastric tubes (NGT). Central venous lines. Umbilical venous catheters. Umbilical arterial catheters.
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Endotracheal tube (ETT) Is clearly recognized in the midline in the neck and upper chest as it has an opaque wall. Ideally the tip of should lie between C7 and T4, 1.2cm below the vocal cords, or 2cm above the level of carina. The position can change considerably with head movement, ,so when the tube is near T4 it could be displaced into the right main bronchus.
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Nasogastric tube (NGT): Is seen in the stomach, it should not be positioned at the gastro-oesophageal junction or above for fluid will reflux into the oesophagus with a risk of aspiration.
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Central Venous Line The central venous line is usually inserted either through: (i) the subclavian vein to the brachiocephalic vein and then superior vena cava (SVC); or (ii) the internal jugular vein into the brachiocephalic vein and into the SVC.
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    Umbilical Venous and  Arterial Catheters
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Umbilical arterial catheter (UAC) The umbilical artery is a direct continuation of the internal iliac arteries, thus; the catheter is recognized by the characteristic loop formed by its entry position into the umbilicus from it loops down into the pelvis to join to the internal iliac artery before passing into the common iliac artery and aorta.
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Two potential positions: *High: T4/6—T9/10 ( above the diaphragm), preferred position *Low: L3-L4 (above the aortic bifurcation/L4-L5) Too low a position should also be avoided to prevent complications of bowel or renal ischaemia, which may occur if the catheter is between T12 and L2. The spinal arteries are at the level of L1-L4. The superior mesenteric artery T12-L2.
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This note was uploaded on 01/21/2012 for the course PDBIO 305 taught by Professor Woods,a during the Fall '08 term at BYU.

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11 - Paediatric Chest Imaging - PaediatricChestImaging The...

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