Central line placement and Sterile technique

Question 1

Shellfish and _____ go hand-in-hand.

Answer 1

iodine

Question 2

Chlorhexidine concentration of > _____ not recommended for procedures such as ____ and other ______ procedures d/t neurotoxicity.

Answer 2

0.5%
epidurals and neuraxial procedures

Question 3

Chlorhexidine results in a lower rate of_______vs iodine

Answer 3

CLABSI

Question 4

Larger sterile drape =

Answer 4

less CLABSI

Question 5

Place CVC _______ to surgical site is draped

Answer 5

prior

Question 6

ABSOLUTE Contraindications of Central Line

Answer 6

-Patient refusal
-Infection at insertion site
-Anatomic obstruction (thrombosis, anatomic variance, carotid disease)
-Superior vena cava syndrome

Question 7

Relative Contraindications of Central Line

Answer 7

-Coagulopathy
-Systemic infection
-Presence of pacing wires or other indwelling catheters at insertion site
-Right ventricular assist device

Question 8

Patient position for procedure

Answer 8

Supine position and Trendelenberg position with head turned 45 degrees away from cannulation site

Question 9

Most Common Insertion Site for Cardiac Anesthesia

Answer 9

Right Internal Jugular Vein (RIJ)

Question 10

Location of the RIJ

Answer 10

-Located between the sternal and clavicular heads of the sternocleidomastoid muscle
-Lateral to carotid artery

Question 11

RIJ has a lower incidence of __________ compared to subclavian vein catheterization

Answer 11

pneumothorax

Question 12

Why does RIJ have lower incidence of pneumothorax when compared to the LIJ?

Answer 12

Due to the lower dome of pleura on right side

Question 13

Right internal jugular vein catheterization avoids ________injury on left

Answer 13

thoracic duct

Question 14

1st step of the central line placement procedure

Answer 14

Locate the apex of the triangle formed by the two heads of the sternocleidomastoid muscle (1st step)

Question 15

Steps for removal of central line catheter

Answer 15

-Place the patient in Trendelenberg position, ask the patient to exhale as the catheter is removed to prevent air embolism
-apply pressure over the site for 1-2 minutes until hemostasis is achieved

Question 16

Highest risk for arterial puncture during procedure

Answer 16

6.25% for femoral = highest risk for this!)

3% for IJ and 0.5% for subclavian

Question 17

Highest risk placement for pneumothorax

Answer 17

SUBCLAVIAN!
(0.1-0.2% for IJ, 1.5-3.1% for subclavian)

Question 18

Classic complication for Pulmonary Artery Rupture

Answer 18

HEMOPTYSIS