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Principles of Anesthesia 1 - (Summer 2024) > Central Lines (Kane) Final Exam > Flashcards

Central Lines (Kane) Final Exam Flashcards

1
Q

What is another name for a central line?

A. Peripheral IV
B. Arterial catheter
C. Central venous catheter
D. Subcutaneous port

A

C. Central venous catheter

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2
Q

Which of the following is NOT a site for central line placement?

A. External jugular
B. Internal jugular
C. Subclavian
D. Radial artery

A

D. Radial artery

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3
Q

Central lines provide access to the circulation via which of the following large veins? (select 4)

A. External jugular
B. Brachial
C. Internal jugular
D. Popliteal
E. Subclavian
F. Radial
D. Femoral

A

A. External jugular
C. Internal jugular
E. Subclavian
D. Femoral

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4
Q

Which of the following is NOT an indication for the use of a central line?

A. Infusion of caustic drugs
B. Administration of total parenteral nutrition (TPN)
C. Measuring arterial blood gas
D. Dialysis access

A

C. Measuring arterial blood gas

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5
Q

Which of the following procedures may require the use of a central line? (2)

A. Infusion of high-concentration potassium chloride
B. Infusion of Albumin
C. Continuous infusion of chemotherapy
D. Intermittent Antibiotics

A

A. Infusion of high-concentration potassium chloride
C. Continuous infusion of chemotherapy

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6
Q

Which conditions may necessitate the use of a central line for monitoring and treatment? (2)

A. Severe burn injuries requiring multiple drug infusions
B. Acute kidney injury necessitating dialysis
C. Skin biopsy
D. Isolated long bone fracture

A

A. Severe burn injuries requiring multiple drug infusions
B. Acute kidney injury necessitating dialysis

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7
Q

Which condition specifically makes a site inappropriate for central line placement?

A. Hypotension
B. Tricuspid valve vegetation
C. Peripheral venous insufficiency
D. Fever of unknown origin

A

B. Tricuspid valve vegetation

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8
Q

Which of the following is a contraindication for central line placement?

A. Hypovolemic shock
B. Renal cell tumor extending into the right atrium
C. Severe dehydration
D. Chronic pain management

A

B. Renal cell tumor extending into the right atrium

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9
Q

Which of the following is a potential complication of central line placement?

A. Hypoglycemia
B. Pneumothorax
C. Hyperthermia
D. Hypotension

A

B. Pneumothorax

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10
Q

What is a common complication associated with central line insertion that involves the vascular system?

A. Myocardial infarction
B. Carotid puncture
C. Deep vein thrombosis
D. Aortic dissection

A

B. Carotid puncture

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11
Q

Which of the following is NOT a potential risks of central line insertion?

A. Trauma to nearby nerves
B. Hemothorax
C. Pulmonary embolism
D. Line-related infection

A

C. Pulmonary embolism

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12
Q

Identifying complications during central line placement is crucial. Which of the following conditions should be monitored? (3)

A. Pneumothorax
B. Line-related infection
C. Carotid puncture
D. Liver failure

A

A. Pneumothorax
B. Line-related infection
C. Carotid puncture

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13
Q

Central Lines are a considered a medical procedure and a _________ needs to be completed before placement can begin.

A. Consent Form
B. Verbal Permission
C. Time Out
D. Surgical Bath

A

C. Time Out

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14
Q

A Contraindication for a Central Line is a Renal Cell tumor that extends into ___________.

a.) Superior Vena Cava
b) Left Jugular Vein
c.) RIght Sublcavian
d.) Right Atrium

A

d.) Right Atrium

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15
Q

Vegetation on the _______ valve is a Contrainfication for a Central Line.

a.) MItral Valve
b.) Pulmonary Valve.
c.) Aortic Valve
d.) Tricuspid Valve

A

d.) Tricuspid Valve

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16
Q

What Central Line placement site do we want to avoid if out patients are ambulatory or having GI incontinence?

a.) Femoral
b.) Subclavian
c.) Internal Jugular
d.) External jugular

A

a.) Femoral

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17
Q

What is the most likely cause of a pneumothorax during a central line insertion?

A) Infection at the insertion site
B) Accidental puncture of the lung
C) Trauma to nearby nerves
D) Dysrhythmias caused by the catheter

A

B) Accidental puncture of the lung

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18
Q

Name the complication for Central Line Placement that occurs when yout have insert the wire into the Ventricle.

a.) Line-related Infection
b.) Carotid Puncture
c.) Trauma to nearby nerves
d.) Dysryhthmias

A

d.) Dysryhthmias

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19
Q

Which of the following are complications of Central Line Placement? (Select 3)

a.) Line-related Infections
b.) Trauma to nearby nerves
c.) Increased ICP
d.) Carotid Puncture

A

a.) Line-related Infections
b.) Trauma to nearby nerves
d.) Carotid Puncture

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20
Q

A Central Line is considered a medical procedure, there for a _______ needs to occur before sticking the patient.

a.) Administration of Anxiolytic
b.) EKG
c.) Written Consent
d.) Time Out

A

d.) Time Out

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21
Q

Name the two muscles that make up the Superior Tip of the triangle for IJ placement.

a.) Sternocleidomastoid Muscle
b.) Sternohyoid Muscle
c.) Scalene Muscle
d.) Thyohyoid Muscle

A

a.) Sternocleidomastoid Muscle
c.) Anterior Scalene Muscle

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22
Q

Name the ideal postion for the patient to be in for a central line placement.

a.) Trendelenburg
b.) Lithotomy
c.) Reverse Trendelenburg
d.) Supine

A

a.) Trendelenburg

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23
Q

Which of the following benefits are associated with the Trendelenburg position during central line placement? (2)

A) Decreases risk of air embolism
B) Improves patient comfort
C) Reduces risk of infection
D) Increases venous return
E) Enhances visualization of the insertion site

A

A) Decreases risk of air embolism
D) Increases venous return

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24
Q

Which sequence correctly describes the prep procedure for central line insertion?

A) Shoulder-chin-sternum-ear-neck
B) Chin-sternum-shoulder-neck-ear
C) Ear-neck-shoulder-sternum-chin
D) Sternum-chin-ear-neck-shoulder

A

B) Chin-sternum-shoulder-neck-ear

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25
Q

What is the correct sequence for draping during a central line placement?

A) Drape from side to side first, then head to foot
B) Drape from head to foot first, then side to side
C) Drape from foot to head, then side to side
D) Drape from side to side only

A

B) Drape from head to foot first, then side to side

10

26
Q

What is the name and size of the needle used to idenitify the Jugular Vein before Ultrasound?

a.) 20 G; looker needle
b.) 22 G; aspirer needle
c.) 23 G; chaser needle
d.) 25 G; seeker needle.

A

d.) 25 G; seeker needle.

12

27
Q

T/F: When using a seeker needle, if you puncture the carotid, it will hemorrhage.

A

False: The seeker needle is small enough that the puncture will self-seal.

12

28
Q

What is the purpose of using the catheter over needle technique in vein identification?

A) To directly administer medication
B) To identify the type of blood vessel by observing blood flow
C) To ensure patient comfort during the procedure
D) To quickly close the insertion site

A

B) To identify the type of blood vessel by observing blood flow

13

29
Q

In the catheter over needle technique, which steps are correctly described?
Select 4

A) Use a seeker needle before/after identifying the vein
B) Insert the needle into the IJ vein with the catheter on
C) Pull the needle out, leaving the catheter in place
D) Immediately start the infusion after catheter insertion
E) Put the wire through the catheter after removing the needle

A

A) Use a seeker needle before/after identifying the vein
B) Insert the needle into the IJ vein with the catheter on
C) Pull the needle out, leaving the catheter in place
E) Put the wire through the catheter after removing the needle

13

30
Q

Which of the following are advantages of using ultrasound for vein identification?
Select 2

A) You don’t have to disconnect and worry about moving the needle out/further into the vessel.
B) Provides a good visual of pressure differences.
C) Allows for continuous monitoring of blood flow.
D) Can tell if you are in the vein/artery based on the blood flows.

A

A) You don’t have to disconnect and worry about moving the needle out/further into the vessel.
D) Can tell if you are in the vein/artery based on the blood flows.

14

31
Q

What are the components of the technique described for vein identification with ultrasound and this type of catheter (see pic)? Select 4

A) Use a syringe with a hole down the middle of its channel.
B) Insert the needle into the neck and put the wire through the channel through the back of the syringe.
C) Observe blood color to determine if in vein or artery.
D) Adjust the needle placement based on ultrasound imaging.
E) Remove the needle after placing the wire through the channel.

A

A) Use a syringe with a hole down the middle of its channel.
B) Insert the needle into the neck and put the wire through the channel through the back of the syringe.
D) Adjust the needle placement based on ultrasound imaging.
E) Remove the needle after placing the wire through the channel.

14

32
Q

What is a disadvantage of using ultrasound and this catheter (see picture) for vein identification?

A) You don’t get a visual of if you are in a vein or artery or a good indicator of pressure.
B) It requires additional training to use effectively.
C) The equipment is very expensive and not widely available.
D) It increases the risk of infection at the insertion site.

A

A) You don’t get a visual of if you are in a vein or artery or a good indicator of pressure.

14

33
Q

What is the primary purpose of using a syringe with a hole down the middle of its channel in this technique?

A) To administer medication simultaneously
B) To avoid disconnecting the syringe while placing the wire
C) To measure the exact blood pressure in the vessel
D) To provide better visualization of the needle insertion

A

B) To avoid disconnecting the syringe while placing the wire

decreases the likelyhood of removing the needle from the vessel

14

34
Q

Which of the following characteristics are true for the internal jugular vein (IJ) in ultrasound imaging? (3)

A) Located lateral to the carotid artery.
B) Thinner walled and compresses easily.
C) Non-pulsatile.
D) Thicker wall; pulsatile.
E) Located medial to the carotid artery.

A

A) Located lateral to the carotid artery.
B) Thinner walled and compresses easily.
C) Non-pulsatile.

15

35
Q

When distinguishing between the carotid artery and the internal jugular vein using ultrasound, which features are correct? (2)

A) The carotid artery has a thicker wall.
B) The internal jugular vein is pulsatile.
C) The carotid artery is non-pulsatile.
D) The internal jugular vein compresses easily.
E) The carotid artery is lateral to the internal jugular vein

A

A) The carotid artery has a thicker wall.
D) The internal jugular vein compresses easily.

15

36
Q

Which statement correctly describes the carotid artery as seen in ultrasound imaging?

A) It has a thinner wall than the internal jugular vein.
B) It is compressible and non-pulsatile.
C) It is thicker walled and pulsatile.
D) It is located lateral to the internal jugular vein.

A

C) It is thicker walled and pulsatile.

15

37
Q

Identify which Vessel is the Carotid Artery and Which Vessel is the Interal Jugular Vein.

A
  • A = Carotid Artery
  • B= Internal Jugular Vein

15

38
Q

Which steps are involved in inserting the J-wire through a needle or catheter? (3)

A) Remove needle.
B) Nick skin to enlarge opening.
C) Insert the J-wire with the ‘J’ pointing away from the heart.
D) Ensure the ‘J’ is going towards the heart.
E) Insert the J-wire through the catheter first, then the needle.

A

A) Remove needle.
B) Nick skin to enlarge opening.
D) Ensure the ‘J’ is going towards the heart.

16

39
Q

Which step is necessary after inserting the J-wire through the needle or catheter?

A) Leave the needle in place.
B) Nick the skin to enlarge the opening.
C) Remove the J-wire immediately.
D) Ensure the ‘J’ is pointing away from the heart.

A

B) Nick the skin to enlarge the opening.

16

40
Q

Which precautions should be taken while advancing the catheter over the J-wire? (4)

A) Never let go of the J-wire.
B) Hold the J-wire at the top by the skin.
C) Twist the catheter in a motion to screw it into the IJ.
D) Release the J-wire once the catheter is in place.
E) Hold the J-wire at the bottom by the skin.

A

A) Never let go of the J-wire.
B) Hold the J-wire at the top by the skin.
C) Twist the catheter in a motion to screw it into the IJ.
E) Hold the J-wire at the bottom by the skin.

17

41
Q

What is the primary reason for holding the J-wire at the bottom by the skin while advancing the catheter?

A) To prevent the J-wire from bending.
B) To ensure the catheter does not collapse on itself.
C) To maintain control of the catheter.
D) To allow for easier insertion of the catheter

A

B) To ensure the catheter does not collapse on itself.

17

42
Q

When can you let go of the J-wire during the procedure?

A) Once the catheter is fully advanced and the J-wire is removed from the body.
B) As soon as the catheter starts to advance.
C) When the J-wire is half-way through the catheter.
D) After the procedure is complete and the site is bandaged

A

A) Once the catheter is fully advanced and the J-wire is removed from the body.

17

43
Q

Why must the cap be removed when removing the J-wire?

A) To prevent backflow of blood.
B) To maintain sterility of the catheter.
C) To allow the wire to exit out the back
D) To facilitate quicker removal of the J-wire

A

C) To allow the wire to exit out the back

18

44
Q

What is the catheter distance for the right internal jugular vein?

A. 14 cm
B. 15 cm
C. 17 cm
D. 18 cm

A

B. 15 cm

19

45
Q

What is the catheter distance for the right subclavian vein?

A. 14 cm
B. 15 cm
C. 17 cm
D. 18 cm

A

A. 14 cm

19

45
Q

What is the catheter distance for the left subclavian vein?

A. 14 cm
B. 15 cm
C. 17 cm
D. 18 cm

A

C. 17 cm

19

46
Q

What is the catheter distance for the left internal jugular vein?

A. 14 cm
B. 15 cm
C. 17 cm
D. 18 cm

A

D. 18 cm

19

47
Q

Which elements should be checked for confirming the placement of a catheter via CXR? select 4

A. Catheter tip
B. No pneumothorax
C. No hemothorax
D. No wire
E. No infection

A

A. Catheter tip
B. No pneumothorax
C. No hemothorax
D. No wire

20

48
Q

True or False

Suture wings and silk thread are used to secure the central line to the skin.

A

True

21

49
Q

When confirming the placement of a right internal jugular catheter via CXR, what should be checked? select 4

A. Position of the catheter tip
B. Absence of pneumothorax
C. Absence of hemothorax
D. Presence of the guide wire
E. Catheter length

A

A. Position of the catheter tip
B. Absence of pneumothorax
C. Absence of hemothorax
D. Presence of the guide wire

22

50
Q

Which finding on the CXR indicate a complication from catheter placement?

A. Catheter tip in the incorrect position
B. Pneumothorax
C. Hemothorax
D. Dislodged catheter
E. Clear lung fields

A

A. Catheter tip in the incorrect position

Kane:Left line goes on a circuitous line. This CXR shows that line is pretty low and need to be pulled quite a bit b/c need to to be on the Cavoatrial Junction of Superior Vena Cava

23

51
Q

What is the diagnosis based on the chest X-ray image provided?

A. Pleural effusion
B. Pneumothorax
C. Pneumonia
D. Pulmonary embolism

A

B. Pneumothorax

Kane: Can see no breath sounds on right side. Need to place chest tube – call the General Surgeon

24

52
Q

What is the diagnosis based on the chest X-ray image provided?

A. Pleural effusion
B. Pneumothorax
C. Hemothorax
D. Pulmonary embolism

A

C. Hemothorax

blood is white on CXR; there is no costophrenic margin on the left chest; Left chest has a meniscus kind of curve.

25

53
Q

What does air appear as on a chest X-ray (CXR)?

A. White
B. Black
C. Gray
D. Red

A

B. Black

25

54
Q

What color does blood appear as on a chest X-ray when diagnosing a hemothorax?

A. Black
B. White
C. Gray
D. Blue

A

B. White

25

55
Q

Which margin is described as having a very acute angle on a lateral chest film when looking for fluid?

A. Costophrenic margin
B. Cardiophrenic margin
C. Hilum margin
D. Apical margin

A

A. Costophrenic margin

Kane: On lateral chest, fill should have very acute costsphrenic margin = where the right chest and diaphragm meet should have downward very acute kind of margin where seeing sort of supine or kind of lateral (and look at both of those)

25

56
Q

What characteristic shape indicates fluid or blood in the chest on an X-ray?

A. Linear shadow
B. Round nodule
C. Meniscus sign
D. Triangle shadow

A

C. Meniscus sign

Kane:Left chest does not have the costphrenic margin. What can be seen are a bunch of something on the base of the left chest. Also beginning to curve = get the meniscus kind of look when fluid sits in a cup, get the curve on the edge of the margin

25

57
Q

What is the key message emphasized about the guidewire in central venous catheterization?

A. Always let the guidewire go.
B. Never let the guidewire go.
C. Sometimes let the guidewire go.
D. Let the guidewire go under supervision.

A

B. Never let the guidewire go.

Two studies: Estimated 1:1611 and Estimated 1:3291 in 2013 articles

26

58
Q

Case #1

What unusual finding was noted 6 months later in the emergency department related to the guidewire?

A. Metallic wire in the patient’s arm
B. Metallic wire in the patient’s leg
C. Metallic wire in the patient’s big toe
D. Metallic wire in the patient’s neck

A

C. Metallic wire in the patient’s big toe

27-28

59
Q

“Our Case”

What was found still in the patient’s neck when sent to rehab after a Fem-pop surgert?

A. A catheter
B. A guidewire
C. A scalpel
D. A needle

A

B. A guidewire

29-30

Principles of Anesthesia 1 - (Summer 2024) (24 decks)

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