Central Lines Flashcards
when is a central line considered correctly placed?
when the distal tip of the catheter is at the junction of the superior vena cava and right atrium
8 indications for central line
- larger IV access to be able to administer fluids and/or blood at a more rapid rate
- allows IV access when peripheral IV attempts failed
- monitor central venous pressure
- insert a pulmonary artery (Swan Ganz catheter)
- administer certain meds that are contraindicated to administer peripherally
- temporary emergency hemodialysis
- place temporary transvenous pacing wires
- to aspirate an air embolism from the heart
3 LONGER TERM indications for central lines
- chemotherapy
- long term antibiotics
- total parenteral nutrition
8 complications of central lines
- infection
- venous stenosis
- accidental arterial puncture
- thrombosis
- pneumothorax
- transient arrhythmias during insertion
- nerve injury
- air embolism
4 signs and symptoms of air embolism
- sudden decrease in end tidal Co2
- sudden increase in end tidal nitrogen
- hypotension/tachycardia
- cyanosis
2 risk factors for development of air embolism
- pt can develop an air embolism during central line placement
- pt can develop an air embolism if the surgical site is above the level of the heart
best method for detecting venous air embolism
TEE
and air embolism is indicated by what?
sporadic roaring sounds
what is the most appropriate method of confirming a venous air embolism in a field avoidance (craniotomy) case?
precordial doppler
6 steps to treating an air embolism
- flood the surgical field with saline
- deliver 100% oxygen
- place pt in left lateral trendelenburg and aspirate the air through a central line port
- give volume to increase central venous pressure
- start a central line and aspirate the air out
- support the patient’s blood pressure
List the veins with the easiest path to the SVC in order
- right IJ
- left subclavian
- Left IJ
- right subclavian
- right and left EJ
the most superficial out of all the central veins
external jugular vein
how is the EJ accessed?
regular IV catheter
2 advantages of IJ
- good visualization with ultrasound
2. the right IJ provides the easiest catheter pathway to the right atrium
4 IJ disadvantages
- close proximity to the carotid artery
- significant risk of infection
- risk of pneumothorax
- uncomfortable to the pt
lowest infection rate and least restricting site
subclavian vein
4 disadvantages to the subclavian
- ultrasound guidance does not provide as much benefit
- this approach carries highest risk of pneumothorax
- bleeding is difficult to control
- pinch off phenomenon or pinch off syndrome is possible
risk of arterial puncture, infection, and venous thromboembolism are highest with this approach
femoral vein
4 risks unique to the femoral approach
- femoral artery puncture
- femoral nerve injury
- bladder perforation
- peritoneal perforation
clinical term that refers to the amount of venous blood returning to the heart (right atrium)
venous return
associated with CVP
venous return
4 factors that affect venous return
- volume status
- intrathoracic pressure
- level of vasodilation
- pt positioning
high intrathoracic pressure causes _____ venous return; while negative intrathoracic pressure ____ venous return
decreases; increases
true/false: trendelenburg lowers venous return
FALSE; higher venous return
normal CVP
5-12 mm Hg
2 purposes for monitoring CVP
- assess pt’s volume and venous return
2. assess right heart function
3 causes of LOW CVP
- hypovolemia
- reverse trendelenburg or sitting beach chair
- vasodilation
treatment for low CVP
volume resuscitation
6 causes for HIGH CVP
- fluid overload
- heart failure
- pulmonary HTN
4.. trendelenburg position - high intrathoracic pressure
6 tricuspid/pulmonary stenosis or regurge.
2 treatments for HIGH CVP
- restricting intraoperative fluids
2. administering an inotrope or a diuretic
A wave
end diastole; atrial contraction
C wave
early systole; ventricular contraction
X descent (mid systole)
atrial relaxation during ventricular systole
V wave
late systole ; blood filling in the right atrium (during relaxation)
Y descent
early diastole; opening of tricuspid valve (just prior to atrial contraction)
an abnormally tall wave on the CVP waveform and refers to tall A waves
cannon wave
3 causes of cannon waves
- tricuspid stenosis
- complete heart block
- junctional rhythm
when can a cannon wave be seen?
tricuspid regurge
In a triple lumen central line, what size is the brown distal central line? what is it used for?
16 ga; CVP
In a triple lumen central line, what size are the two proximal white blue lumens?
18 ga
In a double lumen central line (7F) what size are the white and brown ports?
16 ga
two lines with introducer port
- 8.5 percutaneous sheath introducer (PSI)
2. double lumen 9 F MAC catheter
types of ports
- pulmonary artery catheter (3 extra ports; CVP, infusions, and PAP monitoring)
- companion catheter
- single lumen infusion catheter
size of dialysis lines
14 F
central lines for longer term therapy 2
- peripherally inserted central catheter (PICC) line
2. tunneled catheter (mediport, broviac)
what vein does the PICC lines go through to get into SVC?
antecubital vein
which lines have a very slow drip rate?
PICC lines
which catheter port is sewn under the skin and requires needle stick for access?
mediport catheter
needle used for access in mediport
huber needle
mediport and broviac catheters require ___ to prevent clot formation inside the catheter
heparin
how much blood should be aspirated into the port for mediport and broviac catheters prior to dosing any fluid or drugs?
10 mL
