Mobile DOPs

Question 1

Where should the tip of an endotracheal tube lie with the head in neutral position?

Answer 1

3–4 cm above the carina.

Question 2

Where should the tip of a tracheostomy tube lie?

Answer 2

Between one-half and two-thirds of the distance from stoma to carina.

Question 3

How should a central venous catheter lie in relation to the SVC?

Answer 3

Tip and line should be parallel to the SVC, not perpendicular; angle of incidence < 40°.

Question 4

What is the ideal position of a central venous catheter tip?

Answer 4

In the lower SVC before the RA, at the level of the carina.

Question 5

Where can the tip of a left IJV or subclavian central line lie?

Answer 5

In RA or upper SVC, as long as it’s parallel and not impinging on the lateral SVC wall.

Question 6

How is a dialysis catheter positioned?

Answer 6

Same as central venous catheter; line and tip parallel to SVC, not perpendicular. Tip may be in the RA.

Question 7

What should be avoided with a pulmonary artery catheter?

Answer 7

No kinks/knots in RA or RV.

Question 8

How far should a pulmonary artery catheter tip extend?

Answer 8

No further than the left or right main bronchus. Should not extend beyond the proximal interlobar pulmonary artery (within 2 cm of the hilum).

Question 9

Where should chest tube side holes be located?

Answer 9

Medial to the inner rib margin, within the pleural cavity.

Question 10

What are the two main chest tube positions and indications?

Answer 10

Apical for pneumothorax; basal for fluid drainage.

Question 11

Where should the tip of an intra-aortic balloon pump (IABP) be?

Answer 11

2–3 cm below the left subclavian artery, between T2–T4 vertebral levels.

Question 12

How can you check if an IABP tip is malpositioned?

Answer 12

If it is ≥ 5 cm below the aortic arch.

Question 13

Where should a nasogastric tube (NGT) tip be located?

Answer 13

Below the diaphragm, at least 10 cm within the stomach.

Question 14

What is the function of an endotracheal tube (ETT)?

Answer 14

Keeps airway open and protected, allows delivery of oxygen, medicine, or anesthesia, and acts as a conduit to the ventilator.

Question 15

What is the purpose of the ETT cuff when inflated to correct pressure?

Answer 15

Seals the trachea for positive pressure ventilation and prevents aspiration.

Question 16

What are the types of endotracheal tubes (ETT)?

Answer 16

Oral or nasal; cuffed or uncuffed; double lumen.

Question 17

Where is the carina located anatomically?

Answer 17

Between T5–T7 vertebral levels.

Question 18

Why is the carina an important anatomical marker?

Answer 18

It helps guide correct positioning of several tubes and lines.

Question 19

What is the ideal position of an ETT tip?

Answer 19

3 cm above the carina (minimum 2 cm, maximum 4 cm).

Question 20

What is the purpose of a double lumen endotracheal tube?

Answer 20

Separates right and left lungs to:

• Prevent spillage of blood/pus to the unaffected lung
• Collapse one lung while ventilating the other
• Allow independent ventilation of each lung.

Question 21

What are some surgical situations requiring double lumen ETT?

Answer 21

Aortic aneurysm repair, pneumonectomy, lobectomy, thoracic surgery.

Question 22

When is a tracheostomy performed?

Answer 22

• Airway obstruction
• Need for prolonged intubation
• Inability to intubate
• Adjunct to major head/neck surgery or trauma
• For airway protection.

Question 23

How long may mechanical ventilation be tolerated with endotracheal intubation before tracheostomy is preferred?

Answer 23

Up to 10 days by ETT; tracheostomy is favoured if ventilation is expected > 21 days.

Question 24

How does a tracheostomy tube differ from an ETT?

Answer 24

Different length and shape; inserted through the tracheostomy site (between 2nd & 3rd tracheal rings).

Question 25

What are the two main types of central venous catheters (CVC)?

Answer 25

Tunneled (long-term) and non-tunneled (short-term).

Question 26

Give examples of tunneled CVCs.

Answer 26

Hickman, Groshong, Portacath.

Question 27

What are non-tunneled CVCs used for?

Answer 27

Temporary access in ICU (e.g., CVL, PICC) to administer drugs and fluids.

Question 28

Indications for central venous line (CVL) insertion?

Answer 28

- Prolonged IV therapies - Administer medications/fluids - Obtain blood tests (central venous O₂ sats) - Administer fluid/blood for large resuscitation - Measure CVP.

Question 29

What is a PICC line and when is it used?

Answer 29

Peripherally inserted central catheter (non-tunneled). Used for chemotherapy, parenteral nutrition, infection treatment, and other meds.

Question 30

Why might a Hickman catheter be chosen instead of a PICC?

Answer 30

Some medications will block a PICC, so Hickman is used instead.

Question 31

What’s important about left-sided CVC placement?

Answer 31

Longer than right-sided due to distance; tip must lie parallel (not perpendicular) to SVC wall to avoid perforation.

Question 32

Where can a left-sided CVC tip be located relative to the carina?

Answer 32

Tip may lie below the carina.

Question 33

What is a hemodialysis catheter and where is its tip placed?

Answer 33

Large calibre catheter for dialysis; tip in proximal RA where blood flow is high.

Question 34

How are tunneled CVCs inserted?

Answer 34

Under sterile conditions in OR; imaged with II, checked with CXR in PACU. Catheter is tunneled under skin, exiting away from insertion site.

Question 35

What is unique about a Portacath compared to other CVCs?

Answer 35

Totally under the skin, can stay up to 5 years, accessed through the skin into the port.

Question 36

How many times can a Portacath be accessed?

Answer 36

Up to 2000 times.

Question 37

What complication may occur with Portacath tips?

Answer 37

Tip may block due to fibrin clot; studied in fluoroscopy with DSA to assess flow.

Question 38

What is unique about a Groshong catheter?

Answer 38

Closed tip with side-wall valve (opens for infusion/aspiration, closed at rest). Requires only saline flush.

Question 39

When is a Groshong catheter used?

Answer 39

Used for long-term IV therapies (e.g., chemotherapy, antibiotics, TPN), especially when heparin avoidance is needed.

Question 40

What is a Hickman catheter?

Answer 40

Tunneled small-bore CVC for long-term infusion. Less prone to blockage than PICCs.

Question 41

When is a Hickman catheter used?

Answer 41

Used for chemotherapy, long-term antibiotics, nutritional supplements, or when PICC is unsuitable.

Question 42

What is a Portacath?

Answer 42

Totally implantable CVC under the skin, lasts up to 5 years, accessed by needle through skin.

Question 43

When is a Portacath used?

Answer 43

Used for very long-term IV access (e.g., chemotherapy, recurrent transfusions, long-term medication).

Question 44

What are the main uses of a central venous catheter (CVC)?

Answer 44

For prolonged IV therapy, large-volume fluid resuscitation, CVP monitoring, administration of blood products, and central venous O₂ saturation measurements.

Question 45

What is a PICC line?

Answer 45

Peripherally inserted central catheter (non-tunneled).

Question 46

When is a PICC line used?

Answer 46

Used for intermediate to long-term therapy — chemotherapy, parenteral nutrition, antibiotics, infection treatment.

Question 47

What is a dialysis catheter?

Answer 47

Large calibre CVC placed in RA for high blood flow.

Question 48

When is a dialysis catheter used?

Answer 48

Used for hemodialysis in ICU or long-term renal replacement therapy.

Question 49

Why might a Hickman catheter be chosen instead of a PICC or Groshong?

Answer 49

Hickman is less likely to block with certain medications and allows long-term reliable infusion.

Question 50

What does a PA catheter do?

Answer 50

Measures right/left heart pressures, cardiac output (thermodilution), and monitors hemodynamics.

Question 51

When is a PA catheter used?

Answer 51

Used for critically ill patients with heart failure, sepsis, shock, or complex fluid management; monitors drug effects and prevents fluid overload.

Question 52

When is an endotracheal tube used?

Answer 52

For airway protection, mechanical ventilation, delivery of oxygen/medication/anesthesia, or during surgery.

Question 53

When is a double lumen ETT used?

Answer 53

For thoracic surgery when one lung needs to be ventilated while the other is collapsed (e.g., pneumonectomy, lobectomy, aortic aneurysm repair) or to prevent contamination between lungs.

Question 54

When is a tracheostomy tube used?

Answer 54

For prolonged ventilation (>21 days), upper airway obstruction, inability to intubate, airway protection, or adjunct in major head/neck trauma or surgery.

Question 55

What is the “wedged position” of a PA catheter?

Answer 55

When the balloon is inflated in a small pulmonary artery branch to measure pulmonary artery wedge pressure (PAWP).

Question 56

Why must the PA catheter not be left in the wedged position?

Answer 56

It occludes the artery, risking pulmonary infarction or artery rupture.

Question 57

What should be done if a PA catheter appears wedged on CXR?

Answer 57

Alert medical staff immediately.

Question 58

What are the indications for pleural or mediastinal drains?

Answer 58

To remove air, blood, or fluid, allowing lung expansion and restoration of negative thoracic pressure.

Question 59

How does the underwater seal in a chest drain work?

Answer 59

Prevents backflow of air or fluid into the pleural cavity.

Question 60

Conditions requiring chest drain insertion?

Answer 60

- Pneumothorax - Lung infection - Pleural bleeding - Malignant or inflammatory effusions (cancer, pneumonia) - Post thoracic/heart/oesophageal surgery.

Question 61

What is an intra-aortic balloon pump (IABP)?

Answer 61

A specialised arterial catheter with a helium balloon, inserted into descending aorta via femoral artery, attached to IABP machine.

Question 62

How does the IABP function?

Answer 62

Inflates in diastole → increases coronary blood flow (O₂ supply). Deflates in systole → reduces afterload, improves systemic blood flow and cardiac output.

Question 63

Indications for IABP?

Answer 63

LV failure, unstable angina, septic shock, post-MI complications, bridge to heart transplant, valvular disease, post-cardiac surgery.

Question 64

Correct position of IABP tip?

Answer 64

Ideally at carina level; lowest acceptable is between carina and left main bronchus.

Question 65

What happens if IABP is malpositioned too high?

Answer 65

Impairs blood supply to head and neck.

Question 66

What happens if IABP is malpositioned too low?

Answer 66

Impairs renal and mesenteric artery supply.

Question 67

Why is helium used to inflate IAB balloons?

Answer 67

Inert, light, diffuses rapidly if rupture occurs, reducing embolism risk.

Question 68

How often should IABP patients be imaged and why?

Answer 68

Daily CXR in supine position to check tip location and prevent cannula kinking.

Question 69

Reasons for nasogastric tube (NGT) insertion?

Answer 69

Inadequate oral nutrition Impaired swallowing/aspiration risk Facial or oesophageal abnormalities/post-surgery Eating disorders Primary disease management.