Central Lines Flashcards
How 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
what are the 8 indications for central lines
- larger IV access to be able to administer fluids and/or blood at a more rapid rate
- useful in trauma, massive hemorrage - IV access when peripheral IV access fails
- allows us to monitor central venous pressure
- With a central line, we can insert a pulmonary artery catheter (Swan Ganz catheter)
- Allows us to administer certain medications that are contraindicated to administer peripherally
- vasopressors, inotropes - temporary emergency hemodialysis
- can use central line to place temporary trans venous pacing wires
- can use a central line to aspirate an air embolism from the heart
where is the most common central line access site when a peripheral IV cannot be obtained?
external jugular (EJ)
From where does a central line allow us to monitor CVP?
superior vena cava to assess pre-load
what does a high CVP usually indicate?
right heart failure
at what size can an air embolism become fatal in adults?
200-300 mL
3-5 mL/kg
What are 3 indications for long term central lines?
- Chemotherapy
- long term antibiotics (Abx)
- total parenteral nutrition (TPN)
the two types of central lines that stay in for a prolonged periods of time
- PICC line
- “tunneled” lines
- mediport
- broviac
8 complications of central lines
- infection
- venous stenosis
- catheter can lead to inflammation, scarring, and possible eventual occlusion
- can be fatal for dialysis patients - accidental arterial puncture
- thrombosis
- associated with multiple attempts - pneumothorax
- transient arrhythmias during insertion
- caused by seldinger wire irritating the myocardium - nerve injury
- air embolism
are central lines or arterial lines less prone to infection
arterial lines due to higher pressure blood flow
How do you rule out an arterial line puncture when placing a central line?
- the color of blood
2. transducing the blood pressure
carotid artery puncture can be avoided by inserting the needle _____ to the carotid pulse when placing a central line
lateral
2 identifications of a pneumothorax on a chest x-ray
- absence of vascular markings and translucency (looks cloudy)
- trachea and mediastinum can be shifted to the contralateral side
a large bubble in the vein that travels to the heart and causes an obstruction in the pulmonary artery
air embolism
4 signs and symptoms of an air embolism
- sudden decrease in end tidal CO2
- due to decrease in pulmonary blood flow - sudden increase in end tidal nitrogen
- hypotension/ tachycardia
- cyanosis
will PaCO2 be increased or decreased in air embolism
increased
2 risk factors for development of an air embolism
- during central line placement
- during placement, the needle and catheter in the vein provides a path for air entrapment - if the surgical site is above the level of the heart
- open veins above the heart will have a lower blood pressure than veins at or below the level of the heart
- the lower blood pressure in those veins makes it easier for atmospheric air to enter
* *risk increases when the patient is hypovolemic
when the blood pressure inside the veins is low, air entrapment becomes (more/less) likely?
more
2 things a CAA can do to prevent an air embolism while placing a central line
- keep the catheter occluded as much as possible until the line is all hooked up
- place the patient in trendelenburg position
- this position increases venous pressure, engorges the vein, and makes air entrapment less likely
what is the best (most sensitive) way to diagnose/detect an air embolism
TEE
on a precordial doppler, what is the indication of an air embolism?
sporadic roaring sounds
in a “field avoidance” (craniotomy), what is the most appropriate method for confirming a venous air embolism
precordial doppler
-placing a TEE probe in this situation is impractical
6 treatments for an air embolism
- flood the surgical field with saline
- prevents further entrainment of air - Deliver 100% oxygen
- immediately place the patient in left lateral trendelenburg and aspirate the air through a central line port
- give volume to increase CVP
- start a central line and aspirate the air out
- support the patients blood pressure
- vasopressors, inotrope
why do you place the patient in left lateral position for treatment of air embolism?
increases the chances that the air will stay in the apex of the right ventricle
-decreases the chances of the air going into the pulmonary artery