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34 Cards in this Set
- Front
- Back
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CVP monitoring, PA monitoring/CV oximetry, transvenous pacing, temp HD, drug admin, fluid resuscitation, aspiration of air emboli, difficult peripheral access, freq blood draws.
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Indications for central line
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RA tumor/clot/TV lesions, surgery (CEA) on ipsilateral side, anticoagulation, prior neck surgery, SVC syndrom?.
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Contraindications for central line
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All vessels are near_____
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Nerves
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Infection, air or thrombus embolism, arrhythmias with placement, hematoma, nerve trauma
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Complications at all sites of insertion
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Short, valveless course to the SVC
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Pro of IJ site
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Consistent location, palpable landmarks, easy access, high success rate
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Pros for IJ site
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IJ site is close to ________ nerve
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Brachial plexus/phrenic
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Pneumothorax, airway compromise if hematoma, hemothorax, chylothorax, cardiac tamponade.
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Cons for IJ site
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Lower rate of infection, higher pt comfort after insertion
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Pros for SC vein site
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SC site is easier to perform in trauma pts with :
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Immobilized c-spine
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Higher incidence of pneumothorax; hemothorax, chylothorax, cardiac tamponade
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Cons for SC vein site
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SC vein is not _______ in case of hemorrhage
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Compressible
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SC vein is not a good site for a ________ pt
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Coagulopathic
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Eliminates many of the complications associated with other sites and is useful in emergencies (reliable anatomy, not in proximity to the airway)
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Femoral vein site
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Best and worst for long term use:
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SC, femoral
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Best and worst for ease of cannulation:
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IJ, SC
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Best and worst for success rate:
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IJ, femoral
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Best and worst for complications- technique related:
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Femoral, subclavian
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RIJ distance from insertion site to RA
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20 cm
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LIJ distance from insertion site to RA
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25 cm
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SC distance from insertion site to RA
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15 cm
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Femoral distance from insertion site to RA
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50 cm
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Preferred technique for line insertion, all sites:
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Seldinger
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EJ is considered a ______
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PIV (use an 18 GA)
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Do not place a TLC in the EJ b/c it is
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Too tortuous
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For IJ and SC sites, use of _____ may help with insertion
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Trendelenburg
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Small gauge needle used to verify location of vessel when using the landmark technique for IJ placement
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Seeker
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Blood color, non pulsatile, ABG, transducer (IV extension tubing):
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Verification when using the landmark technique for IJ placement
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When using u/s, you use the ____ axis for locating the vessel location
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Short
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You can use the ______ to verify placement for all techniques.
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CVP tracing
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The catheter tip should be just superior to or at the junction of the _____ and the RA
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SVC
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The catheter tip should be _____ to the vessel walls.
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Parallel
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The catheter tip should be _____ the inferior border of the clavicles.
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Below
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The catheter tip should be above the level of the _______ interspace/carina
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3rd rib/T4-5
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