Key Learning Points

1. 1. Chest X-ray anteroposterior (AP) films magnify the heart and mediastinum, and obscure the left lower zone.

2. 2. When assessing the correct positioning of internal jugular central venous catheter placement, as a rule of thumb, the tip should lie at the level of the carina and to the right of the mediastinum.

3. 3. When assessing the correct positioning of an endotracheal tube, the tip should lie 5–7 cm above the carina.

4. 4. When assessing the lung fields, divide the lungs into three zones: upper, middle and lower thirds. Compare each side and check for asymmetry.

5. 5. Consolidation refers to small airways and alveoli that are filled with material – pus, fluid, blood or cells. Consolidation is not synonymous with infection.

Key Learning Points

1. 1. There are different types of tubes for different indications.

2. 2. For ease of insertion, keep the tubes in the fridge, ensure good lubrication and optimise head positioning.

3. 3. Use the pH of the aspirate, and/or a chest radiograph, to check positioning.

4. 4. On a chest radiograph, a correctly sited nasogastric tube should pass down the midline and bisect the carina, before passing below the diaphragm.

5. 5. If initiating nasogastric feeding, start thinking about long-term feeding plans early, as in practice, these can take a while to sort out.