Chapter 13 Flashcards

Question

What is the Seldinger Technique?

Answer 1

The easiest way to access the vessels. The general term for insertion of a guidewire for placement into ducts. A catheter is inserted into an artery (usually femoral) and positioned into the ostia of the L coronary system. Contrast is injected and x-rays are taken and lesions of the system are outlined. Catheters are exchanged and repeated for the R coronary system.

Answer 2

-1% Xylocaine -#11 Blade -Needle/Cannula set (Deep enough to spam from skin to vessel and is inserted at a 45-60 degree angle) -Guidewire -Catheter -Contrast Medium

Answer 3

1. Skin and Subq are injected w local (xylocaine) 2. Small incision is made w an 11 blade 3. Subq is spread w a kelly 4. Needle/cannula is inserted into the artery at a 45-60 degree angle. Stylet is then slowly withdrawn until there is a spurt of blood. 5. Guidewire is inserted into the cannula of the needle 6. Needle cannula is removed by sliding off the guidewire and digital pressure is applied to prevent the loss of bleeding 7. Distal tip of the catheter threaded over the guidewire and into the artery 8. Catheter is positioned at the proper level and guidewire is removed 9. Catheter is flushed w hepsaline to prevent clotting 10. Contrast is injected 11. X-rays are taken under fluoroscopy

Answer 4

A pigtail catheter is positioned through the aortic valve and into the L ventricle. Chamber pressures are measured and recorded into and cath is hooked up to a pressure injector for injection of a large amount of contrast into the L ventricle. The L ventricular wall is outlined and examined. Ejection Fraction is calculated from this.

Answer 5

A Swanz-Ganz pulmonary catheter is attached to a transducer and a monitor. Pressures are taken in the R atrium to r/o ventricular failure, hypovolemia, or embolism. Pressures are taken in R ventricle to r/o mitral valve insufficiency, L ventricular failure, and CHF. Pressures are taken in the pulmonary artery to r/o pulmonary artery resistance, hypoxemia, respiratory insufficiency, pulmonary edema, and pulmonary embolism.

Answer 6

1. Catheter is inserted into a vein and advanced into the superior vena cava and positioned into the R atrium for chamber pressure measurements. 2.When a R atrial waveform appears on the oscilloscope, the balloon is inflated to facilitate advancement through the tricuspid into the R ventricle where a waveform also appears. 3. Cath is advanced into the pulmonary semilunar valve where a waveform is noted and recorded. 4. The flow of blood will carry the balloon into a smaller branch of the pulmonary artery branches where it wedges and occludes the vessels and pulmonary capillary wedge pressure is recorded. 5. The balloon is deflated and the catheter slips back into the pulmonary artery where pressure is recorded.

Answer 7

End-diastolic pressures and is an important determinant in the functioning of the left side of the heart

Answer 8

Performed intraop during a lapchole for common bile duct exploration. A cholangiogram catheter is inserted through a small incision in the cystic duct. Contrast is injected into the biliary system to detect the presence of caliculi or obstruction under x-ray/fluoroscopy.

Answer 9

Used to outline the structures of the urinary system (usually in conjunction w a cystoscopy procedure). Contrast is used to outline the renal pelvises and ureter. Usually includes KUB.

Answer 10

Intravenous Pyelogram (IVP): Contrast is delivered into a vessel. aka antegrade pyelogram. Retrograde: Contrast is delivered into distal ureter

Answer 11

Uses radioactive meds to assist primarily in locating tumors, their size, and invasiveness. Two types are positron emission tomography (PET) scan and scintigraphy. Radiotracers are introduced to the body via IV, gas inhalation, or gas inhalation and will uptake to abnormalities. Time is dependent on the radiotracer and tagged biological chemical.

Answer 12

Combines CT and radioisotope imaging. Uses radiotracers often, the radioactive drug FDG (fluorodeoxyglucose) which tags glucose bc malignant tissue use higher quantities of glucose. This lights up on the scan. PET scans are lengthy and expensive.

Answer 13

A nuclear medicine study or radionuclide imaging where a radioactive isotope/radiotracer is instilled which are metabolized by a specific tissue type. The more active a cell is, the more of the isotope it will take up (hot spots). Gamma rays are then used to pick up gamma rays emitting from hot spots creating an image. Used for the brain, breast, cardiac, gastroesophageal, skeletal, and thyroid.

Answer 14

1. Magnetic field. A spinning hydrogen atom is placed into a magnetic field, forcing atoms to line up and “spin” at a particular frequency. 2. Radio Waves. Applied radio waves force the hydrogen atoms to cycle in phase. As the radio waves shut down, the atoms release a radio wave of the characteristic frequency that is measured and transformed into an image.

Answer 15

-MRI slices can be taken from any direction -Uses no ionizing radiation -Good for imaging soft tissue, brain disorders, and herniated discs

Answer 16

-A non-iodine based contrast medium can be injected to enhance structures. Images are taken before and after contrast injection. Gadolinium is most commonly used and works by using a chelating process in which large organic molecules form a stable complex around the gadolinium ions and reduces the chances of toxicity. This should not be used for pts w kidney disease bc there is a risk for nephrogenic cystic fibrosis. -Take longer than CTs (can provide sedation or open MRIs can be used) -Makes loud noises (provide music) -No magnets near MRI (pure titanium implants are okay)

Answer 17

A crystal transducer is electrically stimulated and produces high frequency sound waves (1-10 million Hz). The waves are then directed at the body then variances in tissue density are reflected back to the transducer as echos.

Answer 18

Used to examine the hear, carotid artery stenosis, blood flow, solid organs, and the abdominopelvic cavity. The waves cannot be passed through air since the echo is reflected in too many directions so not used on the lungs and the bladder should be full.

Answer 19

The Doppler monitor measures blood flow that transmits the sound of moving red blood cells to the transducer. The difference in pitch can be amplified by the machine. Used in the OR to determine the patency of arterial anastomosis. The probe must be covered by a sterile drape.

Answer 20

A noninvasive ultrasound study of the heart through the chest wall where waves echo from the heart and surrounding structures to provide information about cardiac structural abnormalities. Color techniques can be used to map blood flow through the heart. Transesophageal echocardiography (TEE) can also be done where the transducer is attached to the end of a gastroscope and put into the esophagus to bring it closer to the heart. Used to asses valvular function, interventricular blood volume, cardiac chamber enlargements, and septal defects.

Answer 21

Used to determine and register variations in the volume of an extremity and the volume of blood passing through a vessel. A pulse volume recorder detects changes in the volume of an inflated air bladder that is expressed on a strip chart recorder. Measures diffuse small vessel arterial disease (Doppler may be used to compare volume v. velocity). Measure the amount of air in the lungs.

Answer 22

Notes changes in venous volume when associated w respiration. Measures and is used to diagnose DVT. Mostly replaced by MRI and ultrasound.

Answer 23

ECG, EEG, and EMG. The body had cells w polarized molecules and the systems communicate via bioelectrical or biochemical. These micro-electric impulses can be used to provide diagnostic info.

Answer 24

Used to detect all forms of heart disease. Electrodes/leads are placed on the arms, legs, and torso (3-5 in OR) and a Holter monitor is worn by the pt to detect dysrhythmias. ECG is also useful for a stress test where HR, BP, and ECG are closely monitored for changes to measure delivery of coronary oxygen and myocardial ischemia for pts w angina.

Answer 25

Records electrical activity of the brain by measuring changes in electric potential. Electrodes are placed on the scalp or on the surface of the brain interop and the signals are picked up, sent to an amplifier, and a wave signal is printed for review. Used to help diagnose seizure disorder, brain tumors, and interop to monitor neuro function.

Answer 26

Records the electrical activity of skeletal muscle. Probe is inserted through the skin and into the muscle. Provides info abt muscle contractility and innervation to diagnose ALS, myasthenia gravis, and carpel tunnel syndrome.

Answer 27

Used during cranial and spinal sx when there is a high risk for nerve injury. Provides immediate electrical nerve velocity feedback from electrodes on pt extremities which indicates if there was a disruption of nerve signals. Allows the surgeon to modify the angle of approach, lessen compression, and use other maneuvers that could reverse the effects on the area being operated on.

Answer 28

Measures arterial sats of hemoglobin w oxygen by passing a light through tissues to determine the optical density of blood. Oxygen rich hemoglobin absorbs infrared light and oxygen deprived hemoglobin absorbs red light. Microprocessor calculates the difference and turns it into a percent. Should measure between 95-97%. Is noninvasive.

Answer 29

Estimates arterial levels of CO2 during mechanical ventilation and measures CO2 that is exhaled. Sensor is located in anesthesia circuit and displays info on a monitor in wave form. Useful in detecting dislocated ET tubes and acidosis.

Answer 30

Obtains info on lung capacity, resistance, and ventilator pressure in numerical and graph form on a monitor. Measures the quantity and rate of inhaled and exhaled air. Useful in detecting asthma, COPD, ARDs, and leaks in the ventilatory system.

Answer 31

Blood is drawn from a pt and visually assessed. Arterial Sats: 96-100% Venous Sats: 60-85%

Answer 32

High: Bone Marrow Disease Low: Anemia, sorosis, or dehydration

Answer 33

High: Dehydration or bone disease Low: Anemia

Answer 34

High: Dehydration Low: Anemia, bleeding, and malignancy

Answer 35

High: Too thick Low: Disseminated Intravascular Coagulation (DIC)

Answer 36

High: Leukemia, infection Low: Immunosuppression

Answer 37

High: Increased bleeding Low: Increased clotting

Answer 38

High: Bleeding out Low: Embolism

Answer 39

The relationship between PT and PTT indicates which clotting factors are missing.

Answer 40

Adult Male: 42-54% Adult Female: 38-46% Pregnant Women: 30-34% (Low limits); 46% (Upper limits) Adult Male (High Altitude): 45-61% Adult Female (High Altitude): 41-56%

Answer 41

Doctors measure a patient’s INR level during a PT-INR test. The PT stands for prothrombin time. The test measures how much time it takes for a patient’s blood to clot. This test ensures that patients are receiving the dosage of warfarin that is right for them. Typical score is between 2-3 but its different for everyone.

Answer 42

Simple void: pt voids into a clean container Clean Catch: cleaning the urinary meatus prior to voiding and “catching” the sample midstream into a sterile collection device Sterile: Perineal prep plus catharized specimen into sterile container 24hr sample: Used to measure electrolytes and nitrogenous waste

Answer 43

-Color -Appearance -Odor -pH -Specific gravity -Proteins -Glucose -Ketones -Microscopic: RBC and WBC -Drug screening

Answer 44

A valuable tool in identifying bacteria. Used as a quick method for determining initial course of tx which may be changed after the culture and sensitivity. Bacteria is exposed to stains of crystal violet and iodine, rinsing with alcohol, and stained again. Bacteria that retain the blue dye are called Gram-positive and those that fade to pink are Gram-negative.

Answer 45

Determines the exact organism and which antibiotics are effective after a 24-hour incubation period. Sterile cotton-tipped applicators are used to swab tissue or fluid. Aerobic and Anaerobic studies may be ordered requiring separate containers. Cultures should immediately be sent to lab to preserve life.

Answer 46

Aerobic: Can grow in oxygen. Found in superficial wounds Anaerobic: Bacteria that lives in the absence of oxygen. Destroyed when exposed to the atmosphere in 10 minutes.

Answer 47

Needle aspiration of cerebrospinal fluid (CSF) from the lumbar area of the spinal column for analysis. Normally clear, if bloody, tx will start ASAP. A culture tests to find germs that can cause infection and a sensitivity test checks to see what antibiotic will work best.

Answer 48

Placement of a needle in the posterior pleural space for analysis of pleural effusion. Used to diagnose cancer or inflammation of the pleura/lung or to remove fluid accumulations. CT and ultrasound can help w placement.

Answer 49

Excision of tissue or aspiration of fluid taken to determine nature of disease. Will few exceptions, all tissue and objects removed from the pt are considered specimens and sent to pathology.

Answer 50

-Percutaneous (core needle) -Fluid washings -Brush sampling -Incisional/excisional -Centesis

Answer 51

Cytological: Study of tissue Histological: Study of cells (aspirated cells)

Answer 52

The removal of fluid through a needle w a syringe attached. Used for cysts, joints, lesions, cavities, and thyroid/lymph nodes. 2 different types: fine needle is less invasive but may not obtain sufficient specimen for examination, core uses a larger needle and can take sample from center of lesion

Answer 53

The collection of fluid with cells usually in the pelvic cavity or bronchi. Washing: Obtained during irrigation and aspiration of fluid. The specimens are then spun down by a centrifuge to receive cells. The cells are then placed on a plate and sprayed w fixative. They are stained and examined under a microscope. Brush: Long flexible wire w a brush is used to capture cells. The CST wipes the brush on a slide to create a smear and cuts off the tip of the brush, placing it in formalin.

Answer 54

Incisional: Removal of a portion of a mass or lesion Excisional: Removal of the entire mass or lesion Both can be processed frozen or permanent

Answer 55

Placed in preservative such as formalin, formaldehyde, NS, dry. The specimen is then placed in a machine that removes fluid and water, replacing it w paraffin. The specimen is then sliced into thin sections which are stained or placed on slides for viewing under a microscope

Answer 56

Used to perform an immediate diagnosis, determine if more tissue needs to be excised, or initiate postop therapy. The tissue is kept dry and placed into a specimen container. Pathologist quick-freezes the tissue sample, cuts thin slices and stains the sections, and views the tissue under the microscope. Not 100% accurate so sent as a permanent section afterwards.

Answer 57

Placement of a needle into a body cavity for removal of fluid for diagnostic or therapeutic purposes

Answer 58

Removal of ascites fluid from the peritoneal cavity, which develops as a result of cirrhosis or cancer of the liver, pancreatitis, or ovarian cancer

Answer 59

Placement of a needle through the abdomen into the uterus and amniotic sac in pregnancy for sampling of the amniotic fluid, which surrounds the developing fetus. Performed around the sixteenth week of gestation, it can detect chromosomal anomalies and the gender of the fetus.

Answer 60

percutaneous insertion of a needle into the pericardial sac to treat cardiac tamponade or to sample pericardial effusion fluid for laboratory culture in cases of infective pericarditis.

Answer 61

Used for direct visualization of internal structures and diagnostic purposes.

Chapter 13 Flashcards

Diagnostic Procedures