Central line

Immunohisto chemistry
 Classical central line

← Ettube central line [classical]

→
↓
central RAJ"ⁿᵗ"°ⁿ

f.f-tipg.fm
Tip @ " c-
* line
↓
cerebral
III for confirmation RA
,

of location -_ CXR
 M→ ÷

(
.
Tunnelled
'

Tunnelled catheter catheter

'
subcutaneous
causes fibrosis
around it tunnel

↓
catheter
remain in
it 's position
Indication
of
•

for longer
Tunnelled catheters
periodic
1
Hemodialysis chemotherapy / TPN
A H
,
" "
Peomacath "
Hickmannline
"

(Tunnelled C.Tunnelled Cath)

Cath )
 Portacath
÷.

subcutaneous
tunnel

a
↑
Post

,, , ahem , , ,*

"

self-sealing silicone
↓
.
: least Risk of Infection
?⃝
PICC -peripheral inserted central line

lP=_
Basilio vein > cephalic vein
 ↑
Seldinger Technique ↑ ① Puncture needle
↓ vein ↑
② gulidewioe
Procedure for insertion

of central catheter

Ñ ( Rt side > Ltside ) ③ Dilator over

✓ the guide
↓ ↓ wire
subclavian Femoral
vein vein
↓ ↓ ↓ ⑨ central line →
1ˢᵗ choice Highest Highest over guidewioe
Risk of Risk of
⑤ Takeout
-

Pneumothorax -

Infection guide wire

-
DVT
central line kit

A-
 D8
-☒☒
Thyroid
cartilage ,

☐ formed
by ②
II↓ of Head
SCM
Trendeley
I Beog Position
Infroqdalliculas ↓
direction town the Head
Rtside
@ suction of
middle -45dB / '
b
/ ↳
feet'the carotid
Medial 43rd Pulse

of clavicle H,

Lateraltoit
IJV
④

PTX
↓

③ Pneumothorax
( Last Resort

②
 Best Parameter

L V
S
Clinical parameter To calculate fluid requirement Lab parameter which
whether resuscitation is For resuscitation indicate sufficient
successful or not tissue perfusion

V v
✓
CVP (central venous pressure) Lactate
Urine output
④ =
4-1-01 SFO
 Umbilical catheter

Arterial vinous
↓ ↓
curved
straight
venous
Arterial
 step 1-01*0 incidence Hand Hygiene
-

-
m.gg
CONS

staph .
,§±mP
Aureus
Catheter related blood stream
infection

Central line associated blood stream

infection

Femoral vein
 [ of CRBSI / CLBSI]

~
>

L
Blood from - central line Brush cytology
Tip culture *
- not preferred
~

Blood from - peripheral line Culture

~

If blood sample of central line shows

5x CFU of same organism which
is present in peripheral blood sample

Res "u1t
 1240 > p63

synaptophysin / chromo gamine / Bombe sin / NSE /

CD 56,57
TTF -1 / Naps in A
↓
" "
Thyroid Transcription Factors
 CARCINOMA ( Epithelial origine ]

SARCOMA ( Mesenchymal origine)

Muscle ( Mesenchymal )

L J S

Muscle Actin)
Csmooth
↓ ↓
↓
Rhabdomyosascomq Angiosascornq
leiomyosaocoma (skeletal Muscle)
 Turn 08
Radio Resistant
HO MP →
pancreas
←
Hcc / Rcc os Melanoma

1- 1- at -
- *

F⊕
Radio Resistant
Tumor

:= g)
 *alia I
Acidic
fiboillaoy Poot .
)D
Ewing 's sarcoma

↓
Radio sensitive
-
 I,

Melanoma
 Long slender
microvilli
ON

Electron
Mesothelioma microscopy
Leukocyte

Reidstesng Berg cell Hodgkin 's

=
Lymphoma
HEY /
=

↓
Breast (Mamma
¥
Prostate Ca
 0
0
↓
Bladder
Bg
=
7.
III =
HRCT > NKCT
 Anterior Most Ethmoid Air cell

Largest ethmoidal cell ( Part

of osteomeatal unite)
① Near optic Nerve Post ethmoidal cell → if Enlarge
↓
Infraorbital compress
optic N
Pneumatic Turbinate
 -
Aggao Nasi

↑
small
Maxillary
sinus

=
Agger Nasi
 ↓
Bony Landmark : Basal Lamina
Part of Middle Turbinate

•
Dge •

1) Infe .
Meatus
↳ NLD

2) Middle Meatus
↳ FR ; Ae ; Max .

3) sup . Meatus
↳ PE

4) spheno ethmoidal
-

Recess
↳ sphenoid
 Chon cha

✗
Bulla sae

Bullae
Ethmoidal is
Uncinate
process
e-
Large maxillary
sin use
 OM U
H
1) Bullae ethmoidal is
2) Uncinate process
3) Infundibulum
4) Hiatus semilunar is

> Infraorbital
ON

& ←0C

on Odi Poster o -

superior