CV procedures Flashcards
What are the indications to do a venipuncture
health screening, pre-operative evaluation and as a diagnostic aid
what are the relative contraindications with venipunctures
patient cannot sit still (child)
skin conditions interfering with access
what are the complications with venipunctures
bleeding (bruising, hematoma)
infection
arterial/nerve injury
what supplies do you need for venipuncture
tourniquet
gloves
alcohol swabs
appropriate needle device (vacutainer, butterfly, syringe)
blood specimen tubes
gauze pads or cotton
why do you usually use 21-22 gauge 1 “ needles for blood draws
smaller bores needles causes TBC hemolysis which may be mistaken for anemia or hyperkalemia
what is the most common method for venipuncture
vacutainer and needle holder
where do you put tourniquet
above antecubital fossa
snug slip knot
what vein is usualy most distended
median cubital
describe method to do venipuncture
nondominant hand to pull traction on skin below vessel to keen if from moving
dominant hand to insert needle at 15-30 degree angle until see flashback of blood
partially withdraw eedle if no flashback and reposition
**release tourniquet before removing needle
apply pressure after
what are the indications for intravenous catheterization
administration of fluids and medications
what are the relative contraindications for intravenous catheterization
patient inability to sit still
skin conditions interfereing with access
what are the complications with intravenous atheterization
bleeding (bruising/hematoma)
infiltration of fluid into subcut tissue
infection
thrombosis
What are the supplies for an IV catheterization
gloves- non sterile
alcohol or betadine
tourniquet
IV catheter
IV tubing
extension or saline lock
skin tape or OpSite
Gauze pads
IV solution
What must you do to the IV tubing before procedure
connect to solution bag and allow fluid to run thorugh tubing then clamp line closed
What veins to you usually select for IV catheter
basilic or cephalic on dorsal forearm
pros and cons of placing IV in metacarpal vein
easiest to visualize but mroe likley to occlude and prone to infiltration
What type of sites do you avoid for IV catheter
areas of flexion and bony prominences
near multiple valves/branches
pre-exisiting catheter sites
anatomic deformities
ipsilateral masectomy or lymph node dissection
ipsi arteriovenous fistula or graft
What type of local anesthetic can you use for IV catheterization
topical lidocaine based cream or ointment (30-60 minutes prior)
injectable lidocaine 1-2% injected 5-10 minutes prior to form a small wheel
how do you place catheter
hold catheter between thumb and middle finger with index on top and at 30 degree angle
needle bevel dacing up and advance until feel a pop into vein and see flashback of blood
lower angle and advance 3-5 mm then slowly slide catheter sheath of needle into vein until only 1-3 mm of catheter remaining visible
withdraw needle completely and occlude blood with pressure then gauze under catheter hub, now can take off tourniquet
attach primed IV tubing and open clamp
how do you known if the IV fluid may be flowing into surrounding tissue and not in vein
patient complains of pain or burning
skin appears to be swelling and not good flow from IV bag
What are the indications for a central line
inability to maintain peripheral venous access
need for access to central circulation (pacemaker or pulmonary artery catheter)
infusion of hypertonic substancesor ones that can sclerose the peripheral veins(TPN or chemotherapeutic drugs)
hemodialysis
what are the cotraindications for a central venous catheter
contralaterla pneumonectomy
bleeding diathesis
operator inexperience
infection at insertion site
recent placement of pacemaker
what are the complications assoc with central venous catheter
arterial puncture
pneumothorax
thombosis
infection
cardiac dysrhythmia
where can you insert a central venous line
subclavian catheter
internal jugular catheter
peripherally inserted central catheter
What are the indications for an EKG
ches pain of suspected ardiac origin
suspected arrhythmia
screening for cardiac conditions (high risk)
pre-operative evaluation
contraindications for EKG
patient inability to sit still
skin conditions
need for basic life support
complications with EKG
skin reaction to adhesive
incorrect interpretation of results
what can you find out on a EKG
arrhythmias
mI and infarction
pericarditis
chamber hypertrophy
electrolyte distuvances
drug toxicity
which BB in heart has a anterior and posterior fasicle
the LBB
What are the names of the leads in 12 lead EKG
3 standard limb leads
3 augmented limb leads
6 precordial leads
where do you place the leads
Right arm (negatives)
Left arm lead one (horizontal) has positive
Left arm lead III has negative
Left Leg both +
describe procedure for EKG placement
patient flat with arms at sides (if not flat obscures EKG so take note)
legs shoulder width apart
wipe areas with alcohol pad and shave any hair in way
R arm white
L arm black
left leg red
describe placement of the 6 precordial leads
V1 (red) 4th intercostal space right sternal border
V2 (yelloq) 4th intercostal space at left sternal border
V4 (blue) 5th intercostal space L midclavicular line
V3 (green) halfway between 2 and 4
V5 (tan) L anterior axillary line same level V4
V6 (violet) midaxillary line same level as V4 and 5
Colors: rygbtv ryan yells good boy to violet
which precordial lead is over tricuspid valve? mitral?
tircuspid is V2
mitral is V4
rate of heart based on big boxes
300 150 100….
300 150 100 75 60 50 43 38
