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PMI > Central Lines > Flashcards

Central Lines Flashcards

1
Q

when is a central line considered correctly placed?

A

when the distal tip of the catheter is at the junction of the superior vena cava and right atrium

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2
Q

8 indications for central line

A
  1. larger IV access to be able to administer fluids and/or blood at a more rapid rate
  2. allows IV access when peripheral IV attempts failed
  3. monitor central venous pressure
  4. insert a pulmonary artery (Swan Ganz catheter)
  5. administer certain meds that are contraindicated to administer peripherally
  6. temporary emergency hemodialysis
  7. place temporary transvenous pacing wires
  8. to aspirate an air embolism from the heart
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3
Q

3 LONGER TERM indications for central lines

A
  1. chemotherapy
  2. long term antibiotics
  3. total parenteral nutrition
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4
Q

8 complications of central lines

A
  1. infection
  2. venous stenosis
  3. accidental arterial puncture
  4. thrombosis
  5. pneumothorax
  6. transient arrhythmias during insertion
  7. nerve injury
  8. air embolism
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5
Q

4 signs and symptoms of air embolism

A
  1. sudden decrease in end tidal Co2
  2. sudden increase in end tidal nitrogen
  3. hypotension/tachycardia
  4. cyanosis
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6
Q

2 risk factors for development of air embolism

A
  1. pt can develop an air embolism during central line placement
  2. pt can develop an air embolism if the surgical site is above the level of the heart
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7
Q

best method for detecting venous air embolism

A

TEE

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8
Q

and air embolism is indicated by what?

A

sporadic roaring sounds

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9
Q

what is the most appropriate method of confirming a venous air embolism in a field avoidance (craniotomy) case?

A

precordial doppler

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10
Q

6 steps to treating an air embolism

A
  1. flood the surgical field with saline
  2. deliver 100% oxygen
  3. place pt in left lateral trendelenburg and aspirate the air through a central line port
  4. give volume to increase central venous pressure
  5. start a central line and aspirate the air out
  6. support the patient’s blood pressure
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11
Q

List the veins with the easiest path to the SVC in order

A
  1. right IJ
  2. left subclavian
  3. Left IJ
  4. right subclavian
  5. right and left EJ
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12
Q

the most superficial out of all the central veins

A

external jugular vein

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13
Q

how is the EJ accessed?

A

regular IV catheter

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14
Q

2 advantages of IJ

A
  1. good visualization with ultrasound

2. the right IJ provides the easiest catheter pathway to the right atrium

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15
Q

4 IJ disadvantages

A
  1. close proximity to the carotid artery
  2. significant risk of infection
  3. risk of pneumothorax
  4. uncomfortable to the pt
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16
Q

lowest infection rate and least restricting site

A

subclavian vein

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17
Q

4 disadvantages to the subclavian

A
  1. ultrasound guidance does not provide as much benefit
  2. this approach carries highest risk of pneumothorax
  3. bleeding is difficult to control
  4. pinch off phenomenon or pinch off syndrome is possible
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18
Q

risk of arterial puncture, infection, and venous thromboembolism are highest with this approach

A

femoral vein

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19
Q

4 risks unique to the femoral approach

A
  1. femoral artery puncture
  2. femoral nerve injury
  3. bladder perforation
  4. peritoneal perforation
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20
Q

clinical term that refers to the amount of venous blood returning to the heart (right atrium)

A

venous return

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21
Q

associated with CVP

A

venous return

22
Q

4 factors that affect venous return

A
  1. volume status
  2. intrathoracic pressure
  3. level of vasodilation
  4. pt positioning
23
Q

high intrathoracic pressure causes _____ venous return; while negative intrathoracic pressure ____ venous return

A

decreases; increases

24
Q

true/false: trendelenburg lowers venous return

A

FALSE; higher venous return

25
Q

normal CVP

A

5-12 mm Hg

26
Q

2 purposes for monitoring CVP

A
  1. assess pt’s volume and venous return

2. assess right heart function

27
Q

3 causes of LOW CVP

A
  1. hypovolemia
  2. reverse trendelenburg or sitting beach chair
  3. vasodilation
28
Q

treatment for low CVP

A

volume resuscitation

29
Q

6 causes for HIGH CVP

A
  1. fluid overload
  2. heart failure
  3. pulmonary HTN
    4.. trendelenburg position
  4. high intrathoracic pressure
    6 tricuspid/pulmonary stenosis or regurge.
30
Q

2 treatments for HIGH CVP

A
  1. restricting intraoperative fluids

2. administering an inotrope or a diuretic

31
Q

A wave

A

end diastole; atrial contraction

32
Q

C wave

A

early systole; ventricular contraction

33
Q

X descent (mid systole)

A

atrial relaxation during ventricular systole

34
Q

V wave

A

late systole ; blood filling in the right atrium (during relaxation)

35
Q

Y descent

A

early diastole; opening of tricuspid valve (just prior to atrial contraction)

36
Q

an abnormally tall wave on the CVP waveform and refers to tall A waves

A

cannon wave

37
Q

3 causes of cannon waves

A
  1. tricuspid stenosis
  2. complete heart block
  3. junctional rhythm
38
Q

when can a cannon wave be seen?

A

tricuspid regurge

39
Q

In a triple lumen central line, what size is the brown distal central line? what is it used for?

A

16 ga; CVP

40
Q

In a triple lumen central line, what size are the two proximal white blue lumens?

A

18 ga

41
Q

In a double lumen central line (7F) what size are the white and brown ports?

A

16 ga

42
Q

two lines with introducer port

A
  1. 8.5 percutaneous sheath introducer (PSI)

2. double lumen 9 F MAC catheter

43
Q

types of ports

A
  1. pulmonary artery catheter (3 extra ports; CVP, infusions, and PAP monitoring)
  2. companion catheter
  3. single lumen infusion catheter
44
Q

size of dialysis lines

A

14 F

45
Q

central lines for longer term therapy 2

A
  1. peripherally inserted central catheter (PICC) line

2. tunneled catheter (mediport, broviac)

46
Q

what vein does the PICC lines go through to get into SVC?

A

antecubital vein

47
Q

which lines have a very slow drip rate?

A

PICC lines

48
Q

which catheter port is sewn under the skin and requires needle stick for access?

A

mediport catheter

49
Q

needle used for access in mediport

A

huber needle

50
Q

mediport and broviac catheters require ___ to prevent clot formation inside the catheter

A

heparin

51
Q

how much blood should be aspirated into the port for mediport and broviac catheters prior to dosing any fluid or drugs?

A

10 mL

PMI (21 decks)

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