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Critical Care Paramedic > 1-7 Peripheral and Central Access > Flashcards

1-7 Peripheral and Central Access Flashcards

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1
Q

What are the disadvantages of ultrasound-guided IV access

A
  • difficult to see when the needle is entering due to shadow effect
  • 2-D view
  • transducer must be held in one hand while the needle is in the other
  • sterile sleeve would be needed for the transducer
  • the gel can get annoying when trying to tape down the IV
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2
Q

Indications for EJ access

A

critically ill or injured patient >8 years old and peripheral vein/IO access is not attainable

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3
Q

Contraindications for EJ access

A

1 Inability to visualize the vein

  • cervical injury
  • obscured landmarks
  • infection over the insertion site
  • patients who can’t tolerate being supine
  • failed attempt on the other side of the neck
  • severe burn
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4
Q

What is the first alternative to an IV in an emergency situation?

A

IO

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5
Q

IO meds reach the heart in ___ sec from the proximal humerus and ___ sec from the tibia

A

1, 4

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6
Q

Is adenosine more effective by IV or IO? By how much?

A

adenosine is 10x more effective when given IO

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7
Q

Which access provides the fastest administration times?

A

IO

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8
Q

Indications for IO access

A
  • hemodynamic instability
  • difficult IV access in unstable patients
  • mass casualty situations
  • cardiac arrest
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9
Q

Contraindications for IO access

A
  • fracture at insertion site
  • any proximal injury to the bone
  • previous IO in the same extremity within the last 24 hours
  • previous sternotomy
  • infection at site
  • absence of landmarks
  • previous surgery at insertion site
  • osteogenesis imperfecta
  • pelvic fx
  • my favorite: prosthetic limb
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10
Q

Can blood be administered through an IO

A

yes

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11
Q

How do you mitigate pain associated with an IO

A

40-100 mg liodcaine slow through IO before med admin

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12
Q

What is the difference between a fistula and a graft?

A

a fistula connects an artery and a vein directly. a graft connects an artery and a vein indirectly, through a tube and graft.

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13
Q

When should you NOT use a hemodialysis shunt for access?

A

Literally most of the time, lol. but also if it isn’t active.

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14
Q

What are the 3 types of CVACs

A

tunneled (, non-tunneled, and subcutaneous vascular access device

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15
Q

What is the requirement for something to be considered a central line?

A

the end of the catheter must terminate in the central circulation.

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16
Q

What can a CVAC measure

A

CVP- central venous pressure (reflects right ventricular preload)

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17
Q

Is a PICC tunneled or non-tunneled? Is it used for short or long-term use?

A

Non-tunneled. It travels through the vein the entire way. Designed for short-term to intermediate-term access.

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18
Q

What are the types of tunneled catheters? How do they differ from non-tunneled.

A
  • hickman
  • broviac
  • groshong
  • SVAD
    tunneled CVACs travel under the skin and terminate away from the venous access site.
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19
Q

Indications for a PICC line

A
  • TPN
  • chemo
  • repeated admin of blood products
  • repeated venous blood sampling
  • fluid or med administration
  • measurement of CVP
20
Q

What is the most thromboresistant tunneled catheter?

A

the Hickman

21
Q

Which tunneled type catheter is typically used for pediatrics

A

the Broviac

22
Q

Which tunneled type catheter has a valve that allows fluid to flow in or out, but remains closed when it is not in use?

A

the Groshong

23
Q

What is an SVAD and what is it used for?

A

a subcutaneous vascular access device: a venous access device that has an injection port, which has a self-closing septum for repeated injections. MUST USE A HUBER NEEDLE AND A HUBER NEEDLE ONLY

24
Q

When flushing a CVAC, you should always leave what type of pressure and why?

A

positive pressure, prevents blood reflux from entering the lumen and clotting off. You don’t want a clot entering back into the catheter.

25
Q

What is an arterial line used for?

A

blood pressure monitoring and blood collection (arterial)

26
Q

Arterial line indications

A
  • pts requiring inotropic support
  • severe cardiac dysfunction
  • frequent ABG analysis: pts in respiratory failure or acid/base disturbances.
27
Q

What medications can be put down an art line.

A

PSYCH- NONE. The art line should be labeled in red to avoid any meds from being administered through the line.

28
Q

What is the preferred site for art line placement?

A

the radial artery

29
Q

What gauge cath is typically used in adults for arterial lines?

A

20g. large gauge catheters increase the risk of thrombosis.

30
Q

What is special about the arterial tubing set?

A

the tubing is short and stiff to reduce resonance

31
Q

What pressure must the 500 mL bag of NS be kept at to overcome arterial systolic pressure and to prevent backflow from the cannula into the tubing?

A

300 psi

32
Q

What is the mechanism of action of the arterial line waveform?

A

The column of saline in the arterial set transmits the pressure changes to the transducer - this is displayed as a waveform

33
Q

What will cause a dampened waveform on an art line waveform?

A
  • blood clots in the systems
  • kinking of the tubing
  • compression of air bubbles
34
Q

What does dampening do to the art line BP measurements

A

dampening underestimates the blood pressure

35
Q

What can cause resonance on an art line waveform?

A
  • long tubing
  • overly stiff, non-compliant tubing
  • partially opened stopcocks
  • increased vascular resistance
  • reverberations in the tubing (like it is touching something metal)
36
Q

How often do art line transducers need to be changed?

A

every 96 hours

37
Q

If the art line catheter dislodges, how long should you hold pressure over the site?

A

5 minutes

38
Q

What are the types of pulmonary arterial catheters?

A

PAC or Swan Ganz

39
Q

Don’t use syringes smaller than ____ mL when accessing a hemodialysis shunt

A

10

40
Q

How is PICC line placement confirmed?

A

x-ray

41
Q

How often do CVADS need to be flushed?

A

After each use or daily

42
Q

All medications should be flushed with ___ mL of NS to avoid clots

A

5

43
Q

what psi can a power PICC handle?

A

300

44
Q

What do you do if a CVAC is infusing sluggishly?

A

flush vigorously with 20-30 mL NS

45
Q

Why do we want to make sure the art line flush bag doesn’t run dry?

A

To prevent an air embolism

46
Q

If the art line transducer is placed too low, the readings will be falsely ____

A

high

Critical Care Paramedic (20 decks)

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