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Patient Monitoring and Instrumentation > Central Lines > Flashcards

Central Lines Flashcards

1
Q

What is the correct placement of a central line?

A
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2
Q

Indications for a central line?

A
  1. Larger IV access to be able to administer fluids and/or blood at a more rapid rate
  2. IV access when peripheral IV attempts failed
  3. Monitor central venous pressure (CVP)
  4. Insert a pulmonary artery (Swan Ganz) catheter
  5. Administer certain medications that are contraindicated to administer peripherally
  6. Temporary emergency hemodialysis
  7. Place temporary transvenous pacing wires
  8. We can use a central line to aspirate an air embolism from the heart
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3
Q

Indications for using a central line for long time use?

A
  1. Chemotherapy
  2. Long term antibiotics (Abx)
  3. Total parenteral nutrition (TPN)
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4
Q

Complications of a central line?

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

Signs and symptoms of an 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

Risk factors for developing an air embolism?

A
  1. During central line placement, vein is open to the atmosphere and can introduce air
  2. A patient can develop an air embolism if the surgical site is above the level of the heart
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7
Q

Best way to reduce the risk of an air embolism during central line placement?

A
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8
Q

Best way to diagnose an air embolism

A

TEE is most sensitive

Other ways:
 Precordial doppler
(In a “field avoidance” case (i.e. craniotomy), precordial doppler is the most appropriate method of confirming venous air embolism, because TEE is impractical)
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9
Q

Treatment for an air embolism?

A
  1. Flood the surgical feild with saline
  2. Deliver 100% oxygen
  3. Immediately place the patient 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 (vasopressors, inotropes, etc)
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10
Q

Of all the central line access sites, which one is the best?

A
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11
Q

Advantages to using the external jugular?

A
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12
Q

Disadvantages to the external jugular?

A
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13
Q

Clinical use for the external jugular?

A
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14
Q

Internal jugular vein advantages?

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

Disadvantages to the internal jugular?

A
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16
Q

Advantages to the subclavian vein?

A
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17
Q

Disadvantages to the subclavian approach?

A
  1. Ultrasound guidance does not provide as much benefit
  2. This approach carries the 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

Why is the axillary vein (infraclavicular approach) safer than the subclavian?

A
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19
Q

Axillary vs. subclavian approach?

A
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20
Q

Advantage to the femoral approach?

A
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21
Q

Disdvantage to the femoral approach?

A
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22
Q

What are risks to the femoral approach?

A
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23
Q

Femoral vein central line placement landmarks?

24
Q

What is venous return?

25
Q

Factors that affect venous return?

A
  1. Volume status
  2. Intrathoracic pressure
  3. Level of vasodilation
  4. Patient positioning
26
Q

What is normal CVP? Purposes of monitoring it?

27
Q

Possible causes of low central venous pressure?

28
Q

Treatment for low CVP?

29
Q

Causes of high central venous pressure?

30
Q

Treatments of high CVP?

31
Q

How does high intrathoracic pressure decrease venous return but increase intracranial pressure?

32
Q

What do all the letters of the CVP waveform mean?

33
Q

What are “Cannon waves”?

34
Q

What are causes of “Cannon A waves”?

35
Q

What is a “Cannon V wave”?

36
Q

What part of the waves are vent. systole and vent. diastole?

37
Q

What french is the triple lumen central line?

38
Q

What is the brown 16g lumen used for?

39
Q

What are the two proximal 18ga lumens (white, blue) used for?

40
Q

What is a double lumen central line (7F) used for?

41
Q

What is indicated by the yellow arrows?

42
Q

What are the two types lines that have an introducer port?

43
Q

What is this port called?

44
Q

What is this port called?

45
Q

Why is a central line with an introducer port indicated?

46
Q

What is the yellow line indicating?

47
Q

What all can you add to a Cordis or 9F MAC catheter?

A
  1. Pulmonary Artery (Swan Ganz) catheter
  2. Companion catheter
  3. Single lumen infusion catheter (SLIC)
48
Q

How large can dialysis central lines get?

49
Q

Why would a dialysis central line be used?

50
Q

What are the two types of central lines for longer term therapy?

51
Q

Where is a PICC line placed?

52
Q

Do PICC lines have slow or fast drip rates?

53
Q

How is a mediport (Portacath) placed?

54
Q

How do you access a mediport?

55
Q

What is broviac access?

56
Q

Since Mediport and Broviac catheters require heparin to prevent clot formation, what should you do before bolusing any drugs or fluids?

57
Q

Adult diameter catheters range from ___F to ___F

Patient Monitoring and Instrumentation (24 decks)

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