1-7 Peripheral and Central Access Flashcards
What are the disadvantages of ultrasound-guided IV access
- 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
Indications for EJ access
critically ill or injured patient >8 years old and peripheral vein/IO access is not attainable
Contraindications for EJ access
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
What is the first alternative to an IV in an emergency situation?
IO
IO meds reach the heart in ___ sec from the proximal humerus and ___ sec from the tibia
1, 4
Is adenosine more effective by IV or IO? By how much?
adenosine is 10x more effective when given IO
Which access provides the fastest administration times?
IO
Indications for IO access
- hemodynamic instability
- difficult IV access in unstable patients
- mass casualty situations
- cardiac arrest
Contraindications for IO access
- 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
Can blood be administered through an IO
yes
How do you mitigate pain associated with an IO
40-100 mg liodcaine slow through IO before med admin
What is the difference between a fistula and a graft?
a fistula connects an artery and a vein directly. a graft connects an artery and a vein indirectly, through a tube and graft.
When should you NOT use a hemodialysis shunt for access?
Literally most of the time, lol. but also if it isn’t active.
What are the 3 types of CVACs
tunneled (, non-tunneled, and subcutaneous vascular access device
What is the requirement for something to be considered a central line?
the end of the catheter must terminate in the central circulation.
What can a CVAC measure
CVP- central venous pressure (reflects right ventricular preload)
Is a PICC tunneled or non-tunneled? Is it used for short or long-term use?
Non-tunneled. It travels through the vein the entire way. Designed for short-term to intermediate-term access.
What are the types of tunneled catheters? How do they differ from non-tunneled.
- hickman
- broviac
- groshong
- SVAD
tunneled CVACs travel under the skin and terminate away from the venous access site.
Indications for a PICC line
- TPN
- chemo
- repeated admin of blood products
- repeated venous blood sampling
- fluid or med administration
- measurement of CVP
What is the most thromboresistant tunneled catheter?
the Hickman
Which tunneled type catheter is typically used for pediatrics
the Broviac
Which tunneled type catheter has a valve that allows fluid to flow in or out, but remains closed when it is not in use?
the Groshong
What is an SVAD and what is it used for?
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
When flushing a CVAC, you should always leave what type of pressure and why?
positive pressure, prevents blood reflux from entering the lumen and clotting off. You don’t want a clot entering back into the catheter.
What is an arterial line used for?
blood pressure monitoring and blood collection (arterial)
Arterial line indications
- pts requiring inotropic support
- severe cardiac dysfunction
- frequent ABG analysis: pts in respiratory failure or acid/base disturbances.
What medications can be put down an art line.
PSYCH- NONE. The art line should be labeled in red to avoid any meds from being administered through the line.
What is the preferred site for art line placement?
the radial artery
What gauge cath is typically used in adults for arterial lines?
20g. large gauge catheters increase the risk of thrombosis.
What is special about the arterial tubing set?
the tubing is short and stiff to reduce resonance
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?
300 psi
What is the mechanism of action of the arterial line waveform?
The column of saline in the arterial set transmits the pressure changes to the transducer - this is displayed as a waveform
What will cause a dampened waveform on an art line waveform?
- blood clots in the systems
- kinking of the tubing
- compression of air bubbles
What does dampening do to the art line BP measurements
dampening underestimates the blood pressure
What can cause resonance on an art line waveform?
- long tubing
- overly stiff, non-compliant tubing
- partially opened stopcocks
- increased vascular resistance
- reverberations in the tubing (like it is touching something metal)
How often do art line transducers need to be changed?
every 96 hours
If the art line catheter dislodges, how long should you hold pressure over the site?
5 minutes
What are the types of pulmonary arterial catheters?
PAC or Swan Ganz
Don’t use syringes smaller than ____ mL when accessing a hemodialysis shunt
10
How is PICC line placement confirmed?
x-ray
How often do CVADS need to be flushed?
After each use or daily
All medications should be flushed with ___ mL of NS to avoid clots
5
what psi can a power PICC handle?
300
What do you do if a CVAC is infusing sluggishly?
flush vigorously with 20-30 mL NS
Why do we want to make sure the art line flush bag doesn’t run dry?
To prevent an air embolism
If the art line transducer is placed too low, the readings will be falsely ____
high
