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Interventions 3 > Arterial Puncture (Mod 8...) > Flashcards

Arterial Puncture (Mod 8...) Flashcards

Femoral, Brachial, Pedal + Veins will be the focus

1
Q

ABG Needle Angles and Gauges: Radial site

A

30-45 needle insertion

  • 23g x 1in
  • 25 G x 5/8 in
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2
Q

ABG Needle Angles and Gauges: Dorsal site

A

30-60 needle insertion

  • 23G x 1in
  • 25G x ⅝in
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3
Q

ABG Needle Angles and Gauges: Brachial site

A

60-90o needle insertion

  • 23G x 1in
  • 25G x ⅝in
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4
Q

ABG Needle Angles and Gauges: Femoral site

A

90 needle insertion

  • 22G x 1¼in,
  • 21G x 1½in, 18G x 1½in
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5
Q

When performing the initial puncture through the skin for a arterial line, what angle should the needle be inserted?

A

30-45 degree angle

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6
Q

While performing an arterial line insertion, once a flash of blood is seen…

A

Stop advancing the needle, drop the angle to 20-30 degrees, then advance the guide wire.

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7
Q

The process of eliminating the effects of atmospheric and hydrostatic pressures on an arterial line transducer is called…

A

Leveling

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8
Q

Optimum placement of a arterial line pressure transducer

A

At the level of the phlebostatic axis or level of the 4 intercostal space in the mid axillary line

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9
Q

Where is the femoral artery in relation to the femoral vein/nerve?

A

NAVY

  • Nerve
  • Artery
  • Vein
  • Y of leg (gap)
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10
Q

Advantages of the Brachial Site

A
  • Closer to hear than radial, less
    subject to low P + flow problems
  • Relatively large + easily
    palpated
  • Distal aspect of humerus
    usually easily accessible
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11
Q

Disadvantages of the Brachial site?

A
  • No good collateral blood
    supply
  • Can be deeply located
  • Nerve close to artery, can be
    hit and cause pain with puncture.
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12
Q

Advantages of Dorsalis Pedis site

A
  • Easily located on dorsum of foot
  • Easily stabilized via surrounding structures
  • Collateral circulation via posterior tibial artery present
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13
Q

Disadvantages of Dorsalis Pedis site

A

More peripheral than femoral + brachial = Increased risk of spasm

  • Deep peroneal nerve in close proximity, can cause pain if hit
  • Foot often first place of edema collection, makes landmarking + pulse hard to locate
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14
Q

Advantages of Radial site

A

Collateral circulation via ulnar artery

  • superficial, relatively easy to palpate + stablize
  • Wrist usually easy access
  • Typically no major nerves in close proximity
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15
Q

Disadvantages of Radial Sites

A
  • More peripheral than femoral,
    makes it somewhat likely to go
    into spasm (risk ⬇ because of
    collateral circulation)
  • Radial veins present both
    sides of artery = ⬆ risk of venous
    draw
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16
Q

Disadvantages of Femoral Sites

A

◾No collateral circulation
(general statement, *see P 16 of
reference for specifics)

◾More susceptible to hematoma
+ infection

◾Hemorrhage may not be
apparent till lots of blood loss
present

◾Puncture can tear intima
causing thrombosis

◾Femoral vein very close =
accidental venous draw more
likely

◾Highly pain sensitive femoral
nerve lies immediately lateral to
femoral artery = easy to hit

◾Femoral artery in groin region
= less easily accessible + lies
relatively deep under the skin
compared to others

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17
Q

Advantages of Femoral Sites

A

Closer to heart than radial = decrease subject to low P + flow problems

  • Larger bore needle may be used
  • Easier to draw blood sample during BP/flow problems
  • Larger size = decreased risk of spasm
  • Bigger artery = easier to palpate, but its deeper
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18
Q

Indications for Arterial lines

A
  • Hemodynamically unstable pt
  • Pt needs frequent ABG/blood work
  • Surgical procedures
  • Pt supported via intra aortic balloon pump
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19
Q

When is a patient considered hemodynamically unstable and in need of a arterial line?

A
  • Gradual/acute hypotension/hemorrhage
  • Hypertensive crisis
  • Pt in need of vasoactive drug
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20
Q

Surgical procedures that would require a arterial line

A
  • Cardiopulmonary bypass
  • Intracranial or spinal cord procedures
  • Major vascular, thoracic, abdominal, or neurological procedures
  • when controlled hypotension needed
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21
Q

What is zeroing the transducuer?

A

Exposing the transducer to atmospheric pressure to set a standard to measure other pressures against

22
Q

What is leveling?

A

Assigning the zero point set by zeroing to a section of the patients body.

  • Done to the phlebostatic axis to the patient
23
Q

Why isn’t the transducer placed above the level of the RA?

A

Setting the transducer above the the RA gives a decreased BP reading.

  • The inverse occurs if placed below the RA
24
Q

Relative contraindications for Arterial lines?

A
  • Pt with peripheral vascular disease (negative Allan’s test)
  • Pts with hemorrhagic disorders
  • Pts on anticoagulants/thrombolytics/antiplatelets, poor clotting function
  • Reynaud’s syndrome (decreased flow to fingers)
  • The area is infected, skin is weeping, site of previous vascular
    surgery, synthetic vascular graft is present
25
Q

What factors would effect the aortic waveform in arterial line monitoring?

A
  • Where its measured
  • Aortic stiffness
  • Circulating catecholamine levels
  • Heart Rate
  • Aortic valve incompetence
  • Vascular resistance
26
Q

What should be analyzed when looking at the arterial line system

A

Compare the BP measured via artline with blood pressure cuff and pulse check.

  • A large discrepancy may indicate a heighted or dampened system which needs correction
27
Q

Causes for a Dampened system?

A
  • Air bubbles in system or
    catheter
  • Thrombus in system of
    catheter tip
  • Catheter tip pressed against
    the vessel wall
  • Tube is kinked
  • P loss from the bag
    or normal saline bag is empty
  • Tubing used is too compliant
  • The transducer = above RA
  • System leak
28
Q

Causes for a Heightened system?

A

Transducer below RA

29
Q

Layers of the vein form outer to inner layer

A
  • Tunica externa
  • Tunica media
  • Tunica intima
30
Q

6 Vein types in the arm

A
  • Basilic vein
  • Cephalic vein
  • Median vein
  • Median antecubital vein
  • Deep forearm veins
  • Brachial
31
Q

Where does the cephalic vein run?

A

Along the lateral (radial) aspect of the arm.

  • also from the wrist to shoulder empties into the axillary vein
  • The cephalic vein is more superficial and easier to access than the basilic vein (basilic is larger)
32
Q

Where does the Basilic Vein run?

A

Largest arm vein of the upper extremity

  • **runs along the medial (ulnar) aspect of the arm from wrist to shoulder
  • begins at the dorsum of hand, crosses the elbow and rains into the brachial vein
33
Q

Where does the median vein run?

A

Forms a y just below the elbow that joins the basilic and cephalic vein

34
Q

where does the Median Antecubital Vein run?

A

Oblique coursing vein at the elbow that joins the basilic and cephalic veins

35
Q

where do Deep forearm veins ruyn?

A

2 or 3 vein that each course with and are named like the corresponding arteries of the forearm (radial and ulna)

36
Q

Brachial vein

A

These veins are the deep veins of the upper arm, usually
paired and smaller than the superficial veins. They travel in
the upper arm parallel to (on either side) the brachial artery
and join with the basilic vein to form the axillary vein.

37
Q

Decision on Gauge depends on what?

A

General rule: Use the smallest gauge to achieve the desired goal (less complications this way)

  1. Where the catheter is going (small or large vein/condition of vein)
  2. What the catheter will be used for (fluids, viscous drugs)
  3. How long the IV will be in
38
Q

How does gauge size work?

A

The smaller the gauge value, the larger the diameter of the catheter/needle:

◾ 14 gauge - major trauma/major surgery (large fluid vol)
◾ 16 gauge - major surgery/large fluid volumes/blood transfusions
◾ 18 gauge - surgery (if large vol/blood transfusions needed)
◾ 20 gauge - routine fluid/drug admin
◾ 22 gauge - pts long term IV therapy/pediatrics/adults with small veins
◾ 24 gauge - neonates/pediatrics/adults with poor venous access

39
Q

What is each gauge size from 14-24 used for (6)

  • Expand into other cards
A

◾ 14 gauge - major trauma/major surgery (large fluid vol)
◾ 16 gauge - major surgery/large fluid volumes/blood transfusions
◾ 18 gauge - surgery (if large vol/blood transfusions needed)
◾ 20 gauge - routine fluid/drug admin
◾ 22 gauge - pts long term IV therapy/pediatrics/adults with small veins
◾ 24 gauge - neonates/pediatrics/adults with poor venous access

40
Q

Deciding on the vein is dependent on:

A
  1. Purpose of infusion (what fluids will be going through)
  2. Duration of therapy (how long will IV be inside)
  3. Location (Certain procedures require certain locations/limbs)
41
Q

Rule of thumb for Vein insertion placement

A

When inserting an IV, choose the most reasonable distal site so proximal IVs on same limb can be done

42
Q

Areas to avoid for IV insertion?

A

◾Areas of flexion (elbows, fingers, etc)

◾Digital veins

◾The inner aspect of the wrist

◾Lower extremities (legs/feet) unless specifically ordered or pt
condition requires. Definitely avoid in diabetic patients

◾Areas where valves are present or the vein bifurcates (splits
in 2)

◾Below/over existing phlebitic (inflamed vein) or interstitial
area

◾On a limb containing an A-V fistula or graft

◾On a limb affected by stroke

◾On mastectomy patients who have had an axillary dissection
(use the limb opposite of the mastectomy. Eg: right mastectomy
= use left arm). Note: mastectomy = breast removal

◾Avoid cord like, tortuous, scarred, or inflamed veins

◾Avoid veins where skin is infected, injured, or inflame `

43
Q

3 main purposes of IV access

A
  1. Replace fluids + electrolytes
  2. Provide parenteral nutrition
  3. Administer meds
44
Q

Methods to help vein dilation

A

◾Tourniquet use

◾Gravity (hang limb below heart level) - with tourniquet use

◾Fist clenching (repeated motion) - with tourniquet use

◾Tapping (gently) - with tourniquet use

◾Warm packs - before tourniquet use

◾Relaxation - with tourniquet use

45
Q

Angle of insertion for vein insertion?

A

10-20 degrees

  • too steep risks passing through the vein
  • Once inside watch for flashback, lower catheter almost parallel to the skin and continue insertion as appropriate
46
Q

What should be done to avoid passing through the veins and getting proper placement when inserting an IV

A

watch for flashback, than lower catheter almost parallel to the skin and continue insertion as appropriate

47
Q

Which artery is more likely to spasm, radial or femoral?

A

The radial artery is more likely to experience spasms compared to the femoral artery.

  • Mainly because the radial artery is smaller in diameter and more susceptible to compression or irritation during medical procedures
  • Additionally, the radial artery tends to have more superficial positioning, making it more vulnerable to external pressure.
48
Q

What gauge and length of needle is used for a Femoral poke? Why is it possible to use this size?

A

22G x 1¼in or 21G x 1½in, 18G x 1½in

  • Femoral artery arteries need larger needles because the artery is deeper and larger in diameter
49
Q

Which vessels and ligaments make up the femoral triangle and what order can you find the vessels going medial to lateral?

A

In terms of vessels and nerves, remember NAVY. The following are the ligaments and muscles surrounding the vessels:

  1. Inguinal Ligament: The inguinal ligament forms the superior boundary of the femoral triangle. It runs from the anterior superior iliac spine to the pubic tubercle.
  2. Sartorius Muscle: The sartorius muscle runs obliquely across the femoral triangle. It is the longest muscle in the human body and forms the lateral boundary of the femoral triangle.
  3. Adductor Longus Muscle: The adductor longus muscle forms the medial boundary of the femoral triangle. It runs from the pelvis to the femur.
  4. Floor (or Base) of the Femoral Triangle: This floor is made up of the iliopsoas muscle posteriorly and the pectineus muscle medially.
50
Q

How long do you apply pressure to the site post arterial puncture procedure? is it the same for each site?

A
  • For larger sites like the femoral artery: 15-30 mins or as long as needed to ensure adequate hemostasis
  • For more superficial and small sites, 5-15 minutes
51
Q

What are the specific indications for femoral puncture over radial puncture?

A
  • Inability to access the radial artery
  • Need for larger catheters or devices (such as in cardiac catheterization)
  • Hemodynamic instability (like shock): provides more reliable access to arterial blood flow, less susceptible to compression
  • Long duration
  • Patient comfort, position is uncomfortable so maybe an alternative site is better
52
Q
A

Interventions 3 (19 decks)

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