Aseptic technique lecture

Question 1

clean vs aseptic vs sterile

Answer 1

clean- reduces overall number of germs, but doesn’t eliminate them (IV start)
aseptic- eliminates microorganisms, sterile equipment (whole procedure bc ppl ant be sterilized) CVC insertion
sterile- completely free of microorganisms via heat, radiation, of chemicals (maybe equipment only)

Question 2

mask vs head cover vs or traffic affect in or aseptic technique

Answer 2

mask- protects hcw
head cover- contamination 3-5x fold
OR traffic- increase risk as more people inside suite

Question 3

benefits of chg and when not to use it

Answer 3

chg last longer and stays on the skin
but not more than .5% for nueraxial, eyes, brain, genitals, etc d/t neurotoxicity

Question 4

when to use iodine

Answer 4

when chg allergy

Question 5

chg vs iodine

Answer 5

chg less clabsi

Question 6

central line indications

Answer 6

tv pacing
vasoactives
parenteral nutrition
high electrolyte
chemo

Question 7

CVC contraindications

Answer 7

absolute- refusal, infection at inseriton site, anatomic obstruction like thrombosis, carotid disease, SVC syndrome
relative- coagulopathy, systemic infection, pacing wires or other catheter at insertion site, RVAD

Question 8

rij anatomy

Answer 8

between sternal and clavicular heads of the SCM muscle
lateral to carotid artery

Question 9

RIJ risk

Answer 9

more likely to become contaminated dt respiratory secretions

Question 10

list of steps for cvc insertion

Answer 10

consent
monitors
peripheral iv access
oxygen if sedation is given
supine and trend w 45 degree head turn contralateral
open kit
wash hands
don gear
use chg prep for 30 seconds (for ij, prep from external auditory meatus to clavicle and to trachea)
if under 2 months, iodine may be used
chg dry time 2 minutes
full body drape

Question 11

when would venous blood be pulsatile

Answer 11

tricuspid regurg
a fib

Question 12

distance from insertion to ra junction

Answer 12

sc- 10
rij- 15
lij-20
fem- 40
r basilic- 40
l basilic- 50

Question 13

complications of cvc

Answer 13

arterial puncture (3% for ij, 0.5% for sc, 6% for femoral)
rbbb
PA rupture
air embolism
nerve injury
hemothorax (0.5% for sc)
ptx (.1% ij, 2% sc)
thoracic duct injury- lsc?
cardiac perf and tamponade

Question 14

complications while obtaining access

Answer 14

art pc
ptx
air embolism
neuropathy
catheter knot

Question 15

complications during cvc residence

Answer 15

bacterial colonization of cath or heart or pa
myocardial/ valve injury
sepsis
thrombus formation
thrombophlebitis
misinterpretation of data

Question 16

complications while floating pa cath

Answer 16

rupture PA
RBBB
RBBB causing 3rd hb if LBBB present
dysrhythmias

Question 17

distance from ra junction to heart chambers

Answer 17

ra- 0-10
rv- 10-15
pa- 15-30
pcwp- 25-35

Question 18

highest risk of puncturing thoracic duct

Answer 18

LIJ
risk chylothorax- lymph in chest

Question 19

when does cvc infection risk rise

Answer 19

72 hours

Question 20

classic presentation of pa rupture

Answer 20

hemoptysis

Question 21

risk factors for pa rupture during CVC insertion

Answer 21

Pt- anticoagulation, hypothermia, advanced age
provider factor- too far, prolonged balloon inflation, chronic irritation of vessel wall, unrecognized wedging, filling w liquid instead of air

Question 22

how can u tell if tip of pa cath is NOT in zone 3

Answer 22

PCWP> PAD
non phaseic PCWP tracing
inability to aspirate blood

Question 23

how to pull cvc

Answer 23

trend
ask patient to exhale
1-2 minutes of pressure

Question 24

how often to monitor for infection

Answer 24

every day

Question 25

how soon can u use cvc

Answer 25

if uncomplicated and urgent, immediately

Question 26

wjere should the cvc tip be

Answer 26

svc-ra junction

Question 27

when connecting the sterile tubing to test for arterial pulsations, what are u looking for

Answer 27

it should not flow higher than the cvpWhen

Question 28

When would venous blood be brighter than normal?

Answer 28

shunting

Question 29

If the patient experiences pvc/ dysrhythmias, what do u do

Answer 29

withdraw the wire immediately

Question 30

how far to advance the dilator

Answer 30

just beyond the skin until a loss of resistance (about 1 inch)

Question 31

ij vein is different than carotid bc

Answer 31

more superficial
larger
oval shaped
compressable

Question 32

pros and difficulties of ij, sc, fem

Answer 32

ij- easiy seen w us, difficuly in MO, risk art px
sc- lower risk dvt, same location in pts, higher risk of ptx
femoral- fast, risk infection, thormbosis, mechanical complications

Question 33

Correct length catheter for rij insertion

Answer 33

16cm cath

Question 34

what view with us

Answer 34

short axis- perpendicular for ij

Question 35

chg dry time

Answer 35

2 min

Question 36

when can u use iodine instead of chg for cvc

Answer 36

if under 2 months old

Question 37

what can u add to chg for more rapid and effective germicidal activity

Answer 37

alcohol

Question 38

max concentration of chg

Answer 38

0.5% for epidurals, nueraxial

Question 39

iodone on face, head, mucous membrane, vaginal, nueraxial?

Answer 39

yes its ok, but decreased efficacy in presence of blood, organic material

Question 40

parachoroxylenol

Answer 40

non toxic with no tissue contraindications
remains effective in the presence of blood

Question 41

Highest risk for arterial puncture

Answer 41

Femoral

Question 42

Highest risk of infection site

Answer 42

femoral

Question 43

Highest risk for ptx

Answer 43

Subclavian

Question 44

Complications while obtaining access

Answer 44

Arterial px
PTX
Air embolism
Neuropathy
Catheter knot

Question 45

Complicaitons during catheter residence

Answer 45

Bacterial colonization
Myocardial / valve injury
Thrombus formation
Misinterpretation of data

Question 46

Complications while floating catheter

Answer 46

Rupture PA
RBBB/ complete HB
Dysrhythmias

Question 47

Distance from each insertino site

Answer 47

10/10 SC
15/20 Rij/ lij
40/40/50 rbasilic/ r femoral/ l basilic