Art lines and CVCs Flashcards
what % of pts lack collateral blood flow?
5%
after releasing pressure on the ulnar artery, flushing of the thumb confirms adequate collateral blood flow within how many seconds?
5 seconds
what phenomenon has preexisting vascular insufficiency? (RP)
raynaud’s phenomenon
Radial, brachial, ulnar, axillary, dorsalis pedis, or femoral artery:
- increased incidence of infection and arterial thrombus?
- don’t attempt if radial artery punctured?
- high rate of kinking?
- most common artery?
- distorted waveform and far distance from aorta?
- possible nerve damage and air/thrombi has quick access to cerebral circulation
- femoral
- ulnar
- brachial
- radial
- dorsalis pedis
- axillary
what gauge is the arrow catheter?
20 gauge
what gauge is the TB syringe needle?
27 gauge
Degrees:
- What degree do you penetrate the artery at?
- What degree do you drop the needle down to before advancing it 1-2 mm?
- 45 degrees
2. 30 degrees
what device do we use to monitor perfusion adequacy to the limb the art line is in?
pulse oximeter
Phlebostatic axis:
- located at which intercostal space?
- how far between the anterior-posterior diameter of the chest?
- 4th ICS
2. halfway between AP diameter of the chest
how many million CVCs are placed in the U.S. per year?
5 million
what % of central line insertions have complications?
15%
hematoma and arterial puncture are most common during which venous catheterization?
femoral
IJ or SC:
- more complications with pneumothorax?
- more complications with arterial puncture & hematoma?
- SC
2. IJ
does SC or IJ have lower incidence of infection?
SC
what is overall incidence % of infection in all CVC line sites?
2%
incidence of catheter related infection rises with the number of days the catheter is in past what day number?
3
incidence of infection with antiseptic coated catheters is reduced how many fold?
4 fold
Thrombosis complications:
- what % of MICU patients get a catheter related thrombosis?
- what % of femoral catheters have a thrombosis?
- what % of subclavians have a thrombosis?
- IJ thrombosis is how many times a greater risk than subclavian?
- 15%
- 21.5%
- 1.9%
- 4 times
chlorhexidine prep decreases catheter infection how many fold?
4 fold
antibiotic coated catheters lower infection rate by what %?
50%
inability to place CVC after 3 attempts increases complications how many fold?
6 fold
practitioners with greater than 50 catheterizations have what fraction of less complications?
half
Femoral placement: what are 3 advantages? 1. high rate of what? (S) 2. no interference with what? (C) 3. no risk of what? (P) what are 4 disadvantages? 1. increased what? (I) 2. increased what? (D) 3 decreased pt what? (M) 4. increased circulation time of what? (D)
- success
- CPR
- pneumothorax
- infection
- DVTs
- mobility
- drug
IJ placement: what are the 4 advantages? 1. optimal access for who? (A) 2. what complication is uncommon? (P) 3. increased rate of what? (S) 4. what is controlled easily? (B) what are the 4 disadvantage? 1. poor landmarks in what pts? (O) 2. not ideal for what type of access? (P) 3. increased incidence of what? (I) 4. difficult access for emergent what? (I)
- anesthesia
- pneumothorax
- success
- bleeding
- obese
- prolonged
- infection
- intubations
Does L or R IJ placement have an increased risk of thoracic duct injury?
L IJ
SC placement: what are the 3 advantages? (IC, BOL, LII) 1. increased what? (C) 2. better landmarks in what pts? (O) 3. lower incidence of what? (I) what are the 6 disadvantages? 1. increased risk of what? (P) 2. what is required for successful placement? (E) 3. frequent catheter what? (M) 4. inability to access from where? (H) 5. difficult placement during what? (C) 6. difficulty to control what? (B)
- increased comfort
- better obesity landmarks
- lower infection incidence
- pneumothorax
- experience
- malposition
- HOB
- CPR
- bleeding,
what is the site choice for severe hypovolemia?
subclavian
The right IJ runs __1.____ to the sternocleidomastoid muscle in the upper neck, ____2.___to it in the triangle of the between the two inferior heads of the sternocleidomastoid muscle (SCM) in the middle of the neck, and ____3.___ the anterior portion of the clavicular head in the lower part of the neck.
- medial
- posterior
- behind
What is the proper CVC cm depth range for:
- right subclavian
- right IJ
- left IJ
- 13-14 cm
- 15-16 cm
- 17-18 cm
Lateral or medial of the femoral pulse?
- vein
- nerve
- medial
2. lateral
what insertion needle angle?
- subclavian
- femoral
- 15 degrees
2. 45 degrees
intrajugular vein should not be deeper than how many cm?
2
the subclavian vein in an adult is what range of cms long and what range of cms in diameter?
3-4 cm long & 1-2 cm in diameter
what are the cm to right atrium?
- subclavian
- right IJ
- left IJ
- femoral
- R AC
- L AC
- 15 cm
- 20 cm
- 25 cm
- 30 cm
- 40 cm
- 45 cm
what are the cm to right ventricle?
- subclavian
- right IJ
- left IJ
- femoral
- R AC
- L AC
- 25 cm
- 30 cm
- 35 cm
- 40 cm
- 50 cm
- 55 cm
what are the cm to right pulmonary artery?
- subclavian
- right IJ
- left IJ
- femoral
- R AC
- L AC
- 40 cm
- 45 cm
- 50 cm
- 55 cm
- 65 cm
- 70 cm
A wave:
- increase atrial pressure cause by what?
- correlates with what wave on an EKG?
- R atrial contraction
2. P wave
C wave:
- slight elevation of the tricuspid valve into the R atrium during when?
- correlates with the end of what on an EKG?
- early ventricular contraction
2. QRS segment
X descent:
- probably caused by the downward movement of the what during systolic contraction?
- occurs before what wave on an EKG?
- ventricle
2. T wave
V wave:
- what causes this wave?
- occurs as what wave is ending on an EKG?
- blood filling the right atrium comes up against a closed tricuspid valve
- T wave
Y descent:
- what produces this descent?
- occurs before what wave on an EKG?
- tricuspid valve opens and blood goes to the right ventricle
- P wave