Central Venous Access

Front 1

The ____of an IV solution determines if it should be delivered by the peripheral or central route.

Back 1

tonicity

Front 2

Can electrolyte shifts happen from solutions that are extremely hyper/hypotonic?

Back 2

yes

Front 3

Can inflammatory and enhanced clotting proccesses happen from hyper or hypotonic shifts?

Back 3

yes

Front 4

can phlebitis or thrombophlebitis happen from hyper/hypotonic solns?

Back 4

yes

Front 5

What is the generally accepted upperlimit for peripheral IV?

Back 5

900 mosml

Front 6

Are hyptonic or hypertonic slns more associated with causing red blood cells to swell? What is an ex. or a sln?

Back 6

hypotonic; 1./4 NS, leading to blood cells swelling and bursting , leading to hemolytic anemia.

Front 7

What type of solution may lead to hemolytic anemia?

Back 7

hypotonic sln such as 1/4 NS.

Front 8

What are the indications for Central Venous Access?

Back 8

Mon.CVP, Administering caustic slns,TPN, poor periph access,trans.cut. p. leads,air emboli aspiration, poor periph.

Front 9

Can Central venous access be used for air emboli aspiration?

Back 9

yes

Front 10

Normal Central Venous Pressure?

Back 10

6-9mmHg

Front 11

What are Central Venous Catheter contraindications?

Back 11

Right atrial tuber, funguating tricuspid valve vegetations

Front 12

What are contraindications for Central Venous line that ipsilateral to the site?

Back 12

CAE, local sepsis

Front 13

What are central venous catheterization complications?

Back 13

pneumothorax, hemothorax,carotid artery punc.cath, air embolism,infection,chylothorax

Front 14

Is the carotid artery more medial or lateral to the internal jugular vein?

Back 14

medial

Front 15

Usually the femoral vein is _____to the artery

Back 15

medial

Front 16

Position of pt for IJV placement

Back 16

slight reverse trendelenburg; head slightly to left.

Front 17

landmarks

Back 17

clavicle and lateral and medial heads of the sternocleidomastoid form triagle; apex is entry point

Front 18

Where does the tip of the catheter of an IJ central venous sit?

Back 18

Tip of the superior vena cava above its junction with the right atrium

Front 19

Why shouldn't antibiotics be added to the insertion site?

Back 19

b/c of risk of increasing catheter colonization w/mulitresistant bacteria or colonizaiton..

Front 20

Should placement of catheter be confirmed radiographically? If yes, when?

Back 20

Yes, after operation

Front 21

What should be done before monitoring or infusing?

Back 21

aspiration of dark venous blood in a 5ml Syringe

Front 22

catheter tips located within the heart or below the pericardial reflection on the SVC inc risk of...

Back 22

cardiac perforation or fatal cardiac tamponade

Front 23

Where should the catheter tip lie?

Back 23

w/in SVC, parall. to vessel walls,below inferior border of clavicles,above level of 3rd rib,T4 T5 int. sp.azygus, carin

Front 24

Where should the catheter be in relation to the carina?

Back 24

above

Front 25

what is the preferred vein?

Back 25

right internal jugular

Front 26

Which pulse should you get before canulation?

Back 26

carotid

Front 27

Diadvantage for substituting a 2 inch 18 g iv catheter for 18 guage thin walled needle?

Back 27

can become kinked more easily and therefore diff to recog arterial pulsatile flow

Front 28

How to confirm?

Back 28

color of blood,transduce pressure frm 18G cath,attach a tubing set to create simple fluid manometer to est. pressur

Front 29

Is continuous pressure transduction a method to confirm placement?

Back 29

yes

Front 30

What did the selinger method replace?

Back 30

catheter through the needle

Front 31

comp. of catheter through needle method?

Back 31

needle larger than catheter results in more comp.of hemmorage and shearing of cath. if withdrawn inapprop

Front 32

major advantage of guidewire tech?

Back 32

allows vascular puncture with smaller needle than with catheter through needle

Front 33

problem w/kits that allow guidewire to be placed directly through syringe plunger w/out disconnecting?

Back 33

impossible to recognize pulsatile return

Front 34

problem with multilumen catheters

Back 34

increases risk of infection, more septations and thicker plastic=more chance of vascular perf.

Front 35

alternative to multilumen catheter?

Back 35

sidearm introducer sheath attached to series of stopcocks w/single lumen cath thru hemostasis valve

Front 36

most common complication of double cannulation tech?

Back 36

arrythmias...other complications not greater than w/ single cannulation

Front 37

what are the complications of the double cannulation tech?

Back 37

facial vein avulsion,catheter entanglement, catheter fracture

Front 38

if a pt has severe bleeding diathesis, which vein should be canulated?

Back 38

external jugular

Front 39

which vein should be canulated with pts w/severe emphysema or lung disease?

Back 39

internal over subclavian

Front 40

which vein has most liklihood of pneumothorax

Back 40

subclavian cannulation

Front 41

which vein would be used for tranvenous pacing catheterization?

Back 41

internal jugular

Front 42

pts with collars due to trauma; which vein?

Back 42

subclavian or femoral

Front 43

Name the various ultrasound tech

Back 43

2-d ultrasound,short focus surface transducer,transesophageal echocardiography,doppler

Front 44

How are large veins distinguished in the ultrasound?

Back 44

lack of pulsatility,marked enlargement during valsalva maneuver,easy compressability w/ultrasound

Front 45

Disadvantages of the left internal jugular

Back 45

pnemothrx due to higher cupola,thor. ductpunc.,smaller than rt,more overlap of carotid art,path not straight

Front 46

thoracic duct is located where?

Back 46

left internal jugular and subclavian veins

Front 47

describe path of left internal jugular cath

Back 47

ij, innonimate (left brachiocephalic),enter svc perpindicularly and tip may imp on lat wall of svc

Front 48

Advantages of subclavian

Back 48

ease of cannulation 4 trauma pts w/clav. collar, less risk of infect, good for long term can, hyperalimen,chemo, comfort

Front 49

which vein is often cannulated w/out a smaller guage finder needle?

Back 49

subclavian

Front 50

which vein cannulation most commonly associated w/pneumothorax?

Back 50

subclavian

Front 51

y is a thin-walled needle preferred over 18 guage catheter for subclavian?

Back 51

18 guage easily kinked over course of catheter

Front 52

which vein provides no risk of arterail cannulation or pneumothorax?

Back 52

subclavian

Front 53

should u use an 18 guage catheter or thin walled needle to intro guide wire with external jugular?

Back 53

18 guage

Front 54

With external jugular, should u use straight or J tipped?

Back 54

J tipped

Front 55

problems with external canulation?

Back 55

diff to visualize and to advance into central circ.

Front 56

Is femoral vein medial or lateral to artery?

Back 56

medial (VAN)

Front 57

where is femoral vein venapuncture done?

Back 57

just below the inguinal ligament

Front 58

femroal vein catheterization can be to which two locations?

Back 58

inferior vena cava close to atriacaval junnction or into common iliac vein

Front 59

Does femoral vein provide intra-ab pressure that correl. with superior svc?

Back 59

yes w/mechanically vent, critically ill. Questionable w/spontan, not supine, marked elev in intrathor or ab.

Front 60

Where is the axillary vein in relation to the axillary artery?

Back 60

abt 1cm medial

Front 61

Are PICCS good for short or long term

Back 61

long

Front 62

Where is venous access for the PICC obtained?

Back 62

antecubitical vein, pref. basilic over cephalic b/c less tortuous.