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Vascular > Chapter 22 The Role of Ultrasound in Central Access Device Placement > Flashcards

Chapter 22 The Role of Ultrasound in Central Access Device Placement Flashcards

1
Q

inadvertent release of air or gas into the venous system

A

air embolism

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2
Q

preexisting veins that enlarge to take flow from neighboring but occluded vessels

A

collateral veins

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3
Q

an abnormal connection or passageway between two organs or vessels; may be caused by trauma or intentionally for therapeutic purposes

A

fistula

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4
Q

The brightness of an ultrasound image, which can be manipulated on most devices

A

gain

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5
Q

a hydrophilic guidewire

A

glidewire

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6
Q

A Nitinol or stainless steel wire used to support sheath or catheter exchanges and to predict vessel patency; measured in diameter and length

A

guidewire

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7
Q

leaking of intravenous fluid from a catheter into the tissue surrounding the vein

A

infiltration

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8
Q

Innermost layer of a vein or an artery; composed of one layer of endothelial cells in contact with blood flow; also known as tunica intima

A

intima

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9
Q

small needles are wires used to make the initial access into a target

A

microintroducer

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10
Q

A sheath that is perforated along the long axis, allowing the device to be split for removal from a catheter

A

peel-away sheath

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11
Q

A type of vascular access device that is typically inserted into a vein of the upper extremity and threaded to achieve a tip location in the distal third of the superior vena cava

A

peripherally inserted central catheter (PICC)

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12
Q

Collection of air in the pleural space (between the lung and the chest wall)

A

pneumothorax

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13
Q

A thin-walled, hollow plastic tube through which wires and catheters can be advanced; measured in Fr size according to the size of the catheter it can accomodate

A

sheath

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14
Q

Narrowing of a vein or an artery because of disease or trauma

A

stenosis

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15
Q

Different reasons for venous access

A

intravenous antibiotic therapy
central venous pressure monitoring and sampling
hemodialysis
chemotherapy
total parenteral nutrition

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16
Q

catheters that allow clinicians to infuce medications and blood components, obtain blood samples, and deliver other exchange therapies

A

Vascular access devices

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17
Q

catheters placed such that the terminal tip of the catheter resides in a central vein, most often the superior vena cava

A

central VAD

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18
Q

single- or dual- lumen devices with the tip remaining in the peripheral vein and do not cross into the axillary vein

A

midline catheteres

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19
Q

Most common places for central VAD placement

A

peripheral
basilic
cephalic
brachial
subclavian
internal jugular
external jugular

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20
Q

The central VAD catheter typically resides ______

A

in the distal third of the SVC or slightly deeper at the atriocaval junction

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21
Q

flow rate of atriocaval junction

A

2000 mL/min

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22
Q

Three categories of VADS

A

nontunneled devices
tunneled devices
implanted ports

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23
Q

VADs that are place percuteaneously into a central or peripheral vein, with the device’s tip residing at the atriocaval junction or in the distal third of the SVC

A

nontunneled central VADs

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24
Q

critical care catheters
temporary dialysis and apheresis catheters
small bore polyurethane or silicone catheters
PICCS

A

nontunneled central VADs

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25
Q

secured at the puncture site with sutures, subcuteaneous securement devices, or adhesive securement devices

A

nontunneled central VADs

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26
Q

placed via a central vein with their tip residing at the atriocaval junction or in the distal third of the SVC

A

Tunneled VADs

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27
Q

tunneled under the skin to an exit site, typically located several centimeters from the puncture site into the vein to provide stability for the device and reduces the risk of device-related infection

A

tunneled VADs

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28
Q

infusions
long term dialysis or apheresis

A

tunneled VADs

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29
Q

VADs with a catheter segment attached to a plastic or titanium reservoir. The entire system is placed under the skin.

A

implanted ports

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30
Q

patients who require intermittent therapy such as weekly or monthly

A

implanted ports

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31
Q

dominant superficial vein of the upper extremity

A

basilic vein

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32
Q

Basilic vein blood flow velocity

A

80 mL/min

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33
Q

vein of first choice for placement of PICCs

A

basilic vein

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34
Q

drains directly into axillary vein, which becomes SVC as it enters chest

A

basilic vein

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35
Q

smallest major vein in upper extremity

A

cephalic vein

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36
Q

blood flow velocity of cephalic vein

A

30 mL/min

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37
Q

least preferred choice for VAD placement in upper extremity

A

cephalic vein

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38
Q

Most common sites for central venous access

A

IJVs
SCVs

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39
Q

The ____ IJV is more preferred for VAD placement because it has a straighter course to the heart

A

right

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40
Q

drain blood from the face and the neck

A

EJV and anterior jugular vein

41
Q

joins IJV at confluence of SCVs and brachiocephalic veins

A

EJV

42
Q

____ are commonly used to attain central venous access, located in the chest, usually directly under the clavicle

A

SCVs

43
Q

terminate in brachiocephalic veins join to form:

A

superior vena cava

44
Q

The IJV is located ____ and _____ to CCA

A

anterior
lateral

45
Q

located in groin medial to CFA

A

Common femoral vein

46
Q

drain blood from lower extremities into external iliac veins

A

common femoral veins

47
Q

most often used for central venous access in emergent situations

A

common femoral veins

48
Q

VAD sonographic appearance

A

parallel hyperechoic linear structure

49
Q

occurs each time a vein is accessed

A

vein damage

50
Q

3 layers of vein

A

intima
media
adventitia

51
Q

innermost lining of vein, single layer of endothelial cells

A

tunica intima

52
Q

leaking of fluid from a catheter into tissue around vein

A

infiltration

53
Q

may occur if catheter passes through wall of vein or slips out of vein

A

infiltration

54
Q

initial needle placed through both walls of vein into neighboring artery

A

arterial venous fistula

55
Q

occurs when access needle is directed to a neighboring structure

A

nontarget puncture

56
Q

one of the most serious and potentially life threatening complications of central venous catheterization

A

pneumothorax

57
Q

occurs when air enters the venous system via the needle, sheath, or device; can result in respiratory compromise or death

A

air embolism

58
Q

typically occur when guidewires are advanced into heart, triggering hearts conduction system

A

cardiac arrhythmias

59
Q

Central venous access may be used in patients requiring which of the following?
a. intravenous antibiotic therapy
b. chemotherapy
c. total parentural nutrition
d. all of the above

A

d

60
Q

Which of the following is NOT one of the most commonly used peripheral access points for VAD placement?
a. basilic vein
b. cephalic vein
c. popliteal vein
d. internal jugular vein

A

c

61
Q

Why is the aortocaval junction a desirable location for placement of the VAD catheter tip?

A

flow rates are around 2000 mL/min

62
Q

What is a type of VAD that is placed percuteaneously into a central or peripheral vein with its end secured at the puncture site?

A

nontunneled central VAD

63
Q

Which of the following is a type of VAD in which the catheter exits the skin away from the puncture site?
a. tunneled central VAD
b. nontunneled central VAD
c. implanted port
d. port-a-cath

A

a

64
Q

Which of the following is NOT a benefit of a tunneled central VAD?
a. reduction of device-related infection
b. more stable device
c. hidden exit site for cosmetic reasons
d. less comfortable for the patient

A

d

65
Q

Implanted ports are typically used in patients who require therapy at what rate?

A

weekly

66
Q

Which of the following veins is typically the first choice for placement of peripherally inserted central catheters?

A

basilic vein

67
Q

For which of the following patients would it be more common to use the saphenous vein for central vascular access placement?
a. a 75 year old woman
b. a 2 day old infant
c. a 35 year old male
d. a 62 year old male

A

b

68
Q

Which of the following describes the preferred use of peripheral cannulas?
a. long term ( >1 week), continuous therapy
b. long term, intermittent therapy
c. therapy lasting several months
d. short term therapy ( <1 week)

A

d

69
Q

Which jugular vein is preferred for central VAD placement?

A

right internal jugular vein

70
Q

Where is the internal jugular vein typically located in relation to the common carotid artery?

A

anterolateral

71
Q

Because of their location around the clavicle, which of the following vessels is more difficult to visualize with ultrasound?
a. axillary vein
b. subclavian vein
c. internal jugular vein
d. basilic vein

A

b

72
Q

Which of the following is a reason to avoid the use of the common femoral vein in VAD placement?
a. difficult to visualize on ultrasound
b. preservation for use for lower extremity bypass grafting
c. low flow rates
d. higher rate of mechanical and infectious complications

A

d

73
Q

Which of the following is NOT included in the initial assessment for potential access sites for VAD placement?
a. patency of the vessel
b. location of vessel in relation to other structures
c. blood flow velocity
d. ability to access the target vessel

A

c

74
Q

How is confirmation of tip placement of a vascular access device typically made?

A

chest x-ray

75
Q

A patient presents to the vascular lab after VAD placement to evaluate the basilic vein in which the device is placed. Upon ultrasound evaluation, the basilic vein is noted to have an irregular intimal surface with low-level echoes within the vein lumen. What do these findings suggest?

A

vein damage with thrombosis

76
Q

Which of the following is one of the most serious and potentially life-threatening complications of central venous catheterization?
a. pneumothorax
b. arteriovenous fistula
c. thrombosis
d. vein wall damage

A

a

77
Q

Which medication would be associated with an increased risk of bleeding during vascular access device placement?
a. clopidogrel
b. warfarin
c. heparin
d. all of the above

A

d

78
Q

Which complication of VAD placement is often transient and result in few, if any, symptoms?
a. vein wall damage
b. cardiac arrhythmias
c. arteriovenous fistula
d. pneumothorax

A

b

79
Q

Ultrasound is being incorporated increasingly to attain access and place vascular access devices in patients with ______.

A

difficult access

80
Q

More centrally located target veins include the ______ and internal _____ veins.

A

subclavian veins
jugular

81
Q

The catheter tip of a vascular access device typically resides in the distal third of the ____ at the atriocaval junction

A

SVC

82
Q

A vascular access device designed to remain in place long term would be a(n) _____

A

nontunneled central vascular access device

83
Q

Vascular access devices with a catheter segment attached to a plastic or titanium reservoir are _____

A

implanted ports

84
Q

Because of the location of the brachial veins next to the brachial artery, there is a higher risk of _______ if the brachial veins are used for peripheral VAD placement

A

inadvertent arterial puncture

85
Q

When accessing the central veins for central VAD placement, the ____ internal jugular vein is preferred because of a straighter course to the heart

A

right

86
Q

Ultrasound allows for _____ assessment of the internal jugular vein before VAD placement as well as dynamic guidance during vein puncture/

A

anatomic

87
Q

Using ultrasound guidance during vein puncture can reduce failure of catheter placement as well as complication rates related to ______

A

insertion

88
Q

When accessing the internal jugular vein, it is important to identify the ______ before attempting cannulation to avoid serious injury

A

common carotid artery

89
Q

Neither the subclavian nor other upper extremity veins should be used for cannulation in patients with _____ to preserve these vessels for hemodialysis in the future.

A

chronic renal insufficiency or chronic kidney disease

90
Q

The ______ veins are typically only used for venous access in emergent situations and in patients in whom other potential access veins are occluded.

A

common femoral

91
Q

Patency of a vessel for potential access is first tested by ______, similar to that used in the assessment of a patient for deep venous thrombosis.

A

compressability

92
Q

On ultrasound, the VAD appears in the lumen of the vein and produces a(n) ______ structure on the image.

A

parallel hyperechoic linear

93
Q

The presence of ______ veins upon physical examination should alert the clinician to potential difficulties in successful placement of VADs.

A

collateral

94
Q

Thrombosis and arteriovenous fistula formation are examples of complications due to _____.

A

vein damage

95
Q

To minimize the impact of ______ puncture, a small access needle should be used.

A

nontarget

96
Q

Difficult or traumatic VAD insertion, hematologic disorders, and concurrent treatment with certain medications all increase the risk of ______ during VAD placement

A

bleeding

97
Q

Using valved sheaths, performing exchange maneuvers efficiently, and assuring that catheter lumens are flushed, secured, and locked will decrease the risk of _____.

A

air embolism

98
Q

When advancing guidewires into the heart during VAD placement, transient, asymptomatic, ______ often occur.

A

cardiac arrhythmias

99
Q
A

Vascular (33 decks)

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