Central Lines Flashcards
What is the correct placement of a central line?
Indications for a central line?
- Larger IV access to be able to administer fluids and/or blood at a more rapid rate
- IV access when peripheral IV attempts failed
- Monitor central venous pressure (CVP)
- Insert a pulmonary artery (Swan Ganz) catheter
- Administer certain medications that are contraindicated to administer peripherally
- Temporary emergency hemodialysis
- Place temporary transvenous pacing wires
- We can use a central line to aspirate an air embolism from the heart
Indications for using a central line for long time use?
- Chemotherapy
- Long term antibiotics (Abx)
- Total parenteral nutrition (TPN)
Complications of a central line?
- Infection
- Venous stenosis
- Accidental arterial puncture
- Thrombosis
- Pneumothorax
- Transient arrhythmias during insertion
- Nerve injury
- Air embolism
Signs and symptoms of an air embolism?
- Sudden decrease in end tidal CO2
- Sudden increase in end tidal nitrogen
- Hypotension/tachycardia
- Cyanosis
Risk factors for developing an air embolism?
- During central line placement, vein is open to the atmosphere and can introduce air
- A patient can develop an air embolism if the surgical site is above the level of the heart
Best way to reduce the risk of an air embolism during central line placement?
Best way to diagnose an air embolism
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)
Treatment for an air embolism?
- Flood the surgical feild with saline
- Deliver 100% oxygen
- Immediately place the patient 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 (vasopressors, inotropes, etc)
Of all the central line access sites, which one is the best?
Advantages to using the external jugular?
Disadvantages to the external jugular?
Clinical use for the external jugular?
Internal jugular vein advantages?
- Good visualization with ultrasound
- The RIGHT IJ provides the easiest catheter pathway to the right atrium
Disadvantages to the internal jugular?
Advantages to the subclavian vein?
Disadvantages to the subclavian approach?
- Ultrasound guidance does not provide as much benefit
- This approach carries the highest risk of pneumothorax
- Bleeding is difficult to control
- “Pinch-off phenomenon” or “pinch-off syndrome” is possible
Why is the axillary vein (infraclavicular approach) safer than the subclavian?
Axillary vs. subclavian approach?
Advantage to the femoral approach?
Disdvantage to the femoral approach?
What are risks to the femoral approach?