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Basics > CVC > Flashcards

CVC Flashcards

1
Q

What is A

A

ballon inflation port

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2
Q

what is B

A

thermistor

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3
Q

What is C

A

proximal port (PAP, CVP)

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4
Q

What is D

A

Distal port (PAP, PAWP)

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5
Q

what is E

A

fluids/ meds port

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6
Q

where is the line in wave A

A

Right atrium

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7
Q

where is the line in wave B

A

right ventricle

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8
Q

what is wave C

A

pulm art (PA)

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9
Q

what is wave D

A

pulm wedge pressure wave
PAWP

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10
Q

where is the swan

A

RA

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11
Q

where is the swan

A

RV

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12
Q

where is the swan

A

PA

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13
Q

where is the swan

A

PAWP

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14
Q

what is A

A

DBP

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15
Q

what is B

A

SBP

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16
Q

what is C

A

diacrotic notch

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17
Q

what is D

A

systole

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18
Q

what is E

A

diastole

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19
Q

what is G

A

aortic valve opens

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20
Q

what is H

A

pressure increase as blood flows into the aorta

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21
Q

what is I

A

aortic valve closes

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22
Q

what is J

A

pressure falls as blood flows out of the aorta

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23
Q

what is 1

A

reduced gradient of upstroke caused by aortic stenosis

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24
Q

what is 2

A

reduced pulse pressure caused by aortic stenosis

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25
Q

what is 3

A

bifid waveform caused by aortic regurg

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26
Q

what is 4

A

increased pulse pressure caused by aortic regurg

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27
Q

what is 5

A

steep down stroke cause by low SVR

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28
Q

what is 6

A

low dicrotic notch caused by low SVR

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29
Q

what is 7

A

high dicrotic notch caused by high SVR

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30
Q

what is A

A

normal A line

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31
Q

what is B

A

aortic stenosis A line

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32
Q

what is C

A

aortic regurg a line

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33
Q

what is D

A

low SVR a line

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34
Q

what is E

A

high SVR a line

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35
Q

what is A

A

IJV

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36
Q

what is B

A

carotid artery

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37
Q

what is C

A

needle

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38
Q

what is D

A

guidewire

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39
Q

what is E

A

catheter

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40
Q

what is 1

A

p wave

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41
Q

what is 2

A

R wave

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42
Q

what is 3

A

T wave

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43
Q

what is 4

A

a wave

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44
Q

what is 5

A

C wave

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45
Q

what is 6

A

v wave

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46
Q

what is 7

A

Y wave

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47
Q

what is 8

A

a wave

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48
Q

what is 9

A

x wave

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49
Q

what is A shaded

A

systole

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50
Q

what is B

A

diastole

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51
Q

what is C

A

x wave
RA relaxing and filling

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52
Q

what is D

A

V wave
R atrium is full

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53
Q

what is E

A

Y wave
RA is emptying

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54
Q

what is F

A

a wave
RA contraction

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55
Q

what is G

A

c wave
tricuspid valve closing

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56
Q

what is A

A

distal lumen port

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57
Q

what is B

A

balloon

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58
Q

what is C

A

thermistor

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59
Q

what is D

A

proximal injection

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60
Q

what is E

A

proximal medication port

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61
Q

what is F

A

balloon inflation stopcock

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62
Q

what is G

A

proximal injection hub

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63
Q

what is H

A

proximal medication hub

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64
Q

what is I

A

thermistor connector

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65
Q

what is J

A

distal lumen hub

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66
Q

what is A

A

suprclavicular fossa

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67
Q

what is B

A

clavicle

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68
Q

what is C

A

Sternocleidomastoid muscle clavicular head

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69
Q

what is D

A

sternal head

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70
Q

what is E

A

cricoid cartilage

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71
Q

what is F

A

suprasternal notch

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72
Q

what is A

A

balloon

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73
Q

what is B

A

balloon port with syringe

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74
Q

what is C

A

pulm art port/ distal port

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75
Q

what is D

A

cvp port
right atrial port
proximal port

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76
Q

what is E

A

thermistor port

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77
Q

what is 1

A

normal CO (4.3)

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78
Q

what is 2

A

low CO (2.5)

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79
Q

what is 3

A

high CO (8.2)

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80
Q

what test do you do prior to placing a radial art line

A

allens test, tests if ulnar blood flow is sufficient

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81
Q

what is risk of femoral art line

A

infection
thrombosis

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82
Q

what is risk of brachial art line

A

kinking

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83
Q

what is risk of axillary art line

A

kinking
infection
occlusion
nerve damage

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84
Q

what is benefit of art line placement with ultrasound

A

safer
more effective

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85
Q

what are indications for art lines

A

-current or anticipated hypotension
-wide blood pressure deviations
-end organ disease necessitating beat-to-beat blood pressure regulation
-multiple blood gas/labs

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86
Q

where do you zero a-line for cerebral perfusion

A

tragus

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87
Q

what is difference between cuff BP and cerebral BP

A

15-20 or 0.75 mmHg for every cm

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88
Q

when are art lines contraindicated

A

vascular insufficiency
smaller end arteries

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89
Q

true or false: preop art lines are sterile

A

False
they are aseptic

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90
Q

what materials do you need for art line

A

-rolled towel
-sterile towel
-tape
-arterial catheter
-lidocaine TB syringe or 25g needle
-pressure bag with transducer flushed and zeroed to phlebostatic axis
-2-0 silk on straight needle
-tegaderm x2
-CHG
-Sterile gloves
-US and probe cover

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91
Q

what else can you use as a probe cover

A

tegaderm

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92
Q

what are the steps to art line placement

A

-palpate/US artery
-CHG
-Lidocaine
-insert needle at 45
-drop angle after flashback
-advance 1-2mm
-insert wire
-thread catheter over wire
-remove wire and check for pulsatile flow
-attach high pressure tubing
-verify arterial waveform
-suture and tegaderm

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93
Q

what ultrasound view do you start with for art line placement

A

out of plane

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94
Q

what ultrasound view do you finish with for art line placement

A

in plane

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95
Q

where should wire/needle/catheter be in artery

A

in middle

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96
Q

where should bevel on art line needle be

A

bevel up

97
Q

what is the supercool view on the butterfly for art line placement

A

bi plane view

98
Q

arteries __________ under ultrasound, veins ________

A

arteries pulsate
veins wink

99
Q

What does the dicrotic notch represent?

A

closure of aortic valve

100
Q

as art lines move more distal SBP__________ and the upstroke is _________

A

SBP increases
steeper upstroke

101
Q

as art lines move more distal DBP ________ and dicrotic notch is _________ and ________ sharp

A

DBP decreases
later and less sharp

102
Q

how does aortic stenosis affect arterial waveform

A

reduced gradient of upstroke,
reduced pulse pressure

103
Q

how does aortic regurgitation affect arterial waveform

A

bifid waveform
increased pulse pressure

104
Q

what causes the bifid waveform on aortic regurgitation art line waveforms

A

backwards flow

105
Q

how does Low SVR affect art waveform

A

steep downstroke
low dicrotic notch

106
Q

how does high SVR affect art waveform

A

high dicrotic notch

107
Q

what are the main complications of art line

A

hematoma
vasospasms
nerve damage

108
Q

what are all the complications of art line

A

hematoma
bleeding
vasospasm
arterial thrombosis
emboli/thrombi
pseudoaneurisms
nerve damage
infections
necrosis
arterial drug injection

109
Q

which art line placement has a higher risk of nerve damage

A

brachial

110
Q

what are risk factors for art line complications

A

prolonged use
hyperlipidemia
repeated attempts
female
extracorporeal circulation
larger catheters in smaller vessels
vasopressors

111
Q

what are indications for central line placement

A

-monitor cardiac filling pressure/CVP
-secure access for vasoactive or peripherally caustic drugs
-rapid infusion fluids (certain lines)
-inadequate PIC access
-PAC insertion (cordis)
-cardiac pacing
-aspiration of air emboli
-temporary hemodialysis

112
Q

what is the law about IVs/fluids

A

poisuilles

113
Q

what is poisuilles law equation

A
114
Q

what are advantages/disadvantages of RIJ CVC

A

Advantages
accessible, good landmark

Disadvantages
Carotid puncture

115
Q

what are advantages/disadvantages of EJ CVC

A

advantages
superficial location, safety

disadvantages
low success, kinks at SC

116
Q

what are advantages/disadvantages of subclavian CVC

A

advantages
accessible, good landmarks

disadvantages
pneumothorax, effusion

117
Q

what are advantages/disadvantages of antecubital CVC

A

advantages
limited complications

disadvantages
low success, thrombosis

118
Q

what are advantages/disadvantages of femoral CVC

A

advantages
high success

disadvantages
sepsis

119
Q

why do you not do L SCL lines

A

chylothorax

120
Q

what are the pros of IJs

A

compressible, ease of insertion
straight shot for PAC
Less chance of pneumo

121
Q

what are the cons of IJs

A

carotid artery puncture possible
difficult in obese/fat neck
increased infection rate

122
Q

what are the pros of scl

A

reliable landmarks and positioning
no restrictions when in C-collor/tracheostomy

123
Q

what are the cons of scl

A

more difficult than IJ
noncompressible (bleed)
risk of pneumo

124
Q

what are the pros of femoral

A

ease of placement
compressible
no risk of pneumothorax
Trendelenburg not necessary

125
Q

what are the cons of femoral

A

increased risk of thrombosis and infection
difficult to float PAC
potential for retroperitoneal hemorrhage
patient must be immobile

126
Q

how do you position for RIJ

A

remove pillows, proper head/neck alignment
supine, head turned to left

127
Q

what are the anatomic landmarks of RIJ

A

suprasternal notch,
clavicle,
sternocleidomastoid muscle

128
Q

what muscle is carotid/IJ between

A

sternal and clavicular heads of the sternocleidomastoid

129
Q

where is IJ in relation to the carotid

A

lateral and slightly anterior

130
Q

what is the technique for RIJ insertion

A

-tilt head down to engorge vessel
-open kit, draw up meds
-flush each port with saline and close (except the distal/brown)
-identify landmarks such as sternocleidomastoid, sternal notch, carotid artery, and nipple/illiac crest

131
Q

why do you not cap the brown/distal port

A

wire threads through it

132
Q

the wire will touch anything within

A

4 feet

133
Q

how many attempts do you make at one site

A

3-4

134
Q

how many sites do you try before a new proceduralist

A

2 sites

135
Q

what do you do if catheter is difficult to remove over wire

A

pull wire and catheter as one unit

136
Q

where do you want the CVC to end up

A

cavoatrial junction, 3-5cm above RA

137
Q

what is the method for SCL insertion

A

-feel clavicle with thumb and find curve of clavicle
-with index finger palpate sternal notch
-insert need and walk off clavicle at a flat trajectory towards the sternal notch

138
Q

do you insert scl at a sharp angle

A

no, shallow angle off of clavicle to avoid pneumo

139
Q

where do you aim needle in SCL line

A

towards sternal notch

140
Q

where are artery and lung in relation to SCL vein

A

artery and lung are deep

141
Q

what is the distance from R IJ to RA

A

15 cm

142
Q

what is the distance from R SCL to to RA

A

15 cm

143
Q

what is the distance from LIJ to RA

A

20 cm

144
Q

what is the distance room L SCL to RA

A

25 cm

145
Q

what is the distance from right femoral vein to RA

A

40 cm

Left 50cm

146
Q

what is the distance from Right median basilic to RA

A

40 cm

147
Q

what is the distance from L median basilic to RA

A

50 cm

148
Q

what does the a wave of CVP represent

A

atrial contraction

149
Q

what does c wave on cvp

A

isovolumetric ventricular contraction (prior to AV opening)

closure of tricuspid valve

150
Q

what does the v wave of CVP represent

A

ventricular contraction and systolic filling of atrium

151
Q

what are the three positive waves of CVP

A

A
C
V

152
Q

what are the three negative waves of CVP

A

X
X1
Y

153
Q

what does the x wave of CVP represent

A

start of atrial diastole

154
Q

what does the X1 wave of CVP represent

A

downward pulling of the septum during ventricular systole

155
Q

what does the y wave of CVP represent

A

descent represents opening tricuspid valve, atrial emptying

156
Q

what are central venous line complications

A

-arterial puncture
-dysrhythmias
-misinterpretation of data
-infection
-pneumothorax/hemothorax
-airway comprimise
-tracheal puncture
-air embolus
-catheter wire shearing
-thrombophlebitis
-cardiac tamponade
-nerve injury

157
Q

what causes dyrythmias in CVC placement

A

tip in RA, pull it back

158
Q

what are indications for PA caths

A

LV dysfunction
two vessel disease/angina within 2 hours
symptomatic valvular disease
severe hypertensive with angina history
large operation with anticipation of intravascular volume changes
vascular surgery with clamp of major artery

159
Q

what surgical case do you usually use PA cath in

A

open hearts

160
Q

what are RELATIVE contraindications to insertion of a PAC

A

-transvenous pacemaker placed in the past 4-6 weeks
-frequent ventricular dysrhythmias uncontrolled with meds
-coagulopathy
-bifasiscicular block
-mobitz 2
-inability to insert into pulmonary artery

161
Q

what creates an inability to insert into pulmonary artery

A

pulmonary HTN
pulmonary/tricuspid regurgitation

162
Q

what is risk of coagulopathy in PAC placement

A

risk of pulm hemorrhage

163
Q

what is risk of mobitz 2 and PA cath placement

A

transition to complete block

164
Q

what are ABSOLUTE contraindications for insertion of a PAC

A

R atrial or R ventricular masses, tumors, or thrombosis
tricuspid/pulmonic valve stenosis
mechanical valve
tetralogy of fallot

165
Q

what is the introducer for Swan

A

cordis

166
Q

where is cordis usually placed

A

right IJ

167
Q

when do inflate balloon in swan placement

A

in RA

168
Q

where do you inject fluid for CO reading in SWAN

A

Right atrial/proximal/blue port

169
Q

what is connected to red port on swan ganz

A

balloon port

170
Q

what is the yellow port of swan

A

pulm art/distal port

171
Q

where is the PAC at 15-20 cm

A

RA

172
Q

what doesPAC tracing look like at 15-20 cm

A

RA so cvp tracing

173
Q

where is PAC at 30 cm

A

RV

174
Q

what does PAC tracing look like at 30 cm

A

in RV so PVC tracing

175
Q

where is the PAC at 40 cm

A

pulm artery

dicrotic notch on tracing

176
Q

where is the PAC at 50-55 cm

A

should be wedged

177
Q

what is the limit of PAC distance

A

65 cm

178
Q

what is BP calculation

A

CO x SVR

179
Q

what is CO calculation

A

HR x SV

180
Q

what are filling pressures related to

A

volume
ventral compliance

181
Q

what affects compliance

A

ischemia,
diastolic dysfunction from valve disease,
intrathoracic pressures

182
Q

what is normal RA pressure

A

5 mmHg

183
Q

what is normal RV pressure

A

25/6 mmHg

184
Q

what is normal PA pressure

A

25/9

185
Q

what is normal PAWP

A

9 mmHg

186
Q

what is normal LA pressure

A

8 mmHg

187
Q

what is normal Left Ventricle Pressure

A

130/8

188
Q

what is normal central aorta pressure

A

130/70 (90) mmHg

189
Q

what is formula for CO

A

CO= HR x SV

190
Q

what is a normal CO

A

5-6 L/min

191
Q

what is formula for CI

A

CO/BSA

192
Q

what is normal CI

A

2.5-4.0L/min

193
Q

how fast do you push fluid for thermodilution measurement

A

3-5 sec

194
Q

what is the accuracy of thermodilution

A

+/- 5-10%

195
Q

what factors affect cardiac filling pressure

A

decreased/increased ventricular compliance
myocardial ischemia
valve dysfunction
increased filling/volume overload
decreased volume/blood loss
increased afterload

196
Q

what causes PCWP to be > than LVEDP (overestimate)

A

positive pressure ventilation
PEEP
increased intrathoracic pressure
COPD
increased pulm vasc resistance
LA myxoma (tumor)
mitral valve disease

197
Q

what causes PCWP< LVEDP (underestimate)

A

noncompliant left ventricle
aortic regurgitation (premature closure of mitral valve)
LVEDP>25 mmHg

198
Q

how does PAC measure CO

A

thermodilution

199
Q

how does thermodilution appear in low CO

A

higher, longer to return to normal

200
Q

how does thermodilution appear in high CO

A

lower, quicker return to baseline

201
Q

what are factors that effect the accuracy of thermodilution

A

inaccurate injectate temp or volume
rapid volume infusion during injection
resp cycle
inaccurate computation constant
patient is cold (thermal instability post CPB)

202
Q

how do we utilize PAC data

A

-measure Co and optimize perfusion (with inotropes)
-detect, treat, and trend myocardial ischemia
-measure and optimize ventricular preload and volume in surgery with large volume shifts
-aortic cross clamp
detect, treat, and trend valvular dysfunction

203
Q

what is calculatoin of CI

A

CO/BSA

204
Q

what is normal CI

A

2.5-4.0 L/min

205
Q

what is SV calculation

A

CO/HR

206
Q

what is normal SV

A

60-90 mL/beat

207
Q

what is calculation for stroke index

A

SV/BSA

208
Q

what is normal SI

A

40-60 ml/beat

209
Q

what is calculation for MAP

A

DBP+1/3 pulse pressure OR
(sys+ 2 diastolic)/3

210
Q

what is the calculation fo systemic vascular resistance (SVR)

A

MAP-CVP/COx80

211
Q

what is normal SVR

A

1200-1500 dynes/cm2

212
Q

what are indications for pacing PAC

A

sinus node dysfunction
symptomatic bradycardia
second degree block
third degree block
digitalis toxicity
need for AV sequential pacing
LBBB

213
Q

what are complications of PAC

A

carotid/SCL artery punction
perforation of RA, RV, pulmonary artery
cardiac dysrhythmias
heart block (RBBB)
knotting of catheter
improper therapy

214
Q

PIV should be on the _________ side as SpO2

A

same

215
Q

PIV should be on the _________ side as BP cuff

A

opposite

216
Q

what are some positioning considerations with PIV placemtn

A

not in AC with bent arms

217
Q

IV should _______ be on the same side as surgical extremity

A

not

218
Q

what are monitoring considerations if arms are tucked

A

2 IVs, 2SpO2s, 2BP cuffs

219
Q

what is the minimum size IV for sx

A

20g

220
Q

what size IV do you use for blood loss/PRBVs

A

18g

221
Q

why is it important to be able to see/monitor IV

A

avoid infiltration

222
Q

what are some IV placement tips

A

side of vessel not on top, hold traction with thump

223
Q

where is the best place to put IV? why?

A

biforcation, wont blow, tough skin,

224
Q

once you get flash with IV how far do you advance catheter to enter vessel

A

1 cm

225
Q

how do you determine what direction to point IV when using ultrasound

A

slide transducer proximally along the arm, ensure vein stays in the center of the screen. the angle of the probe tells you the path of the vein

226
Q

which side of arm is basilic vein on

A

medial

227
Q

which side of arm is cephalic vein on

A

lateral

228
Q

what does basilic and brachial vein become

A

axillary vein

229
Q

what does axillary and cephalic vein become

A

subclavian

230
Q

what are benefits of basilic vein cannulation

A

success rate 60-75%
avoid trendelenburg

231
Q

T/F long term arm cannulation is discouraged in basilic vein cannulation

A

true

232
Q

where is resistance felt in basilic vein cannulation, how do we combat it

A

axillary region
abduction and external rotation of arm
running IV to help bypass valves (flush)

233
Q

how do you help pass basilic vein cannulation up ipsilateral IJ

A

turn head towards side of venapuncture

234
Q

what is distance from R basilic vein to RA

A

40 cm

235
Q

what is distance from L basilic vein to RA

A

50 cm

236
Q

what do we do for difficult IV

A

use ultrasound
use different locations
use volatiles to dilate vessels
EJ
angiocath

237
Q

what are risks of mask induction in OR with no IV

A

laryngospasm
aspiration
prolonged stage 2 in adults (longer induction)

238
Q

Pulm vascular resistance equation

A

PAP-PCWP/ CO x 80

Normal 100-300 dynes/cm2

239
Q

Systemic vascular resistance equation

A

MAP-CVP/CO x 80

Basics (7 decks)

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