CVP

Question 1

After insertion of CVP for a patient in ICU His oxygen saturation dropped and started To be tachycardic .

Q1: Given the following x rya what is your diagnosis ?

Answer 1

Rt T. Pneumothorax
Mediastinal shift / black shadow on rt side / Rt lung is collapsed

Question 2

Q2. is this x ray adequate ?

Answer 2

No, because we cannot see C-Ph angle / According to X-ray whether CP angle present or not

Question 3

Q3: types of pneumothorax ?

Answer 3

Open / Closed
Simple / Tension
1ry / 2ry

Question 4

Q4.difference between tension and simple ?

Answer 4

S; trachea not shifted / no cvs compromise / no hypoxia
T; trachea will be shifted / hypoxia / CVS compromisation / Emergnecy thoracotomy.

Question 5

Q5 . safe triangle for insertion ?

Answer 5

Ant; Lat border of Pec M. / Post; Lat border of Latismus / Inf; a line drawn from nipple backwards

Question 6

Q7. complications of central venous line insertion ?

Answer 6

Immediate; Injury of surrounds (Pulmonary, Vascular), arrythmia, Cardiac tamponade
Late; Infection and thrombosis and stenosis

Question 7

Q6. indications for central line insertion ?

Answer 7

Monitor Fluid balance
TPN
Hemodialysis
Failed prephiral Access
Certain drugs and meds

Question 7

Q9. removal technique ?

Answer 7

Pt lying down straight and applying pressure after to prevent hematoma

Question 8

Q8. NICE guidelines for insertion ?

Answer 8

Insertion under ultrasound guidance
* Post procedure radiograph for:
o Position of the radiopaque tip in SVC just superior to its entry in RA
o Pneumothorax

Question 9

Q10. indications for removal ?

Answer 9

• Resolution of the acute problem Cessation of support
• Pt is being discharged home
• Line sepsis

Question 10

Q11: sites of insertion ?

Answer 10

IJV / Subclav V. / PICC. And .
……… Femoral V

Question 11

Q12: organism causing infection ?

Answer 11

Staph epidemrids / Aureus

Question 12

Q13: how to prevent

Answer 12

infection ?
- Hand hygiene
- Skin antiseptic and ensure it has been dried
- Sterile barriers; Gown / gloves / cap / mask / drape
- After insertion; follow recom maintainance practices / wash hand before and after touching it / removal once no longer needed

Question 13

Q14: most common line prone to infection ?

Answer 13

Femoral V

Question 14

Q. Name of technique of insertion?

Answer 14

Seldinger

Question 15

Q. Explain the Technique
.

Answer 15

Technique for Insertion of Central Venous Line (IJV)
1. Identify Anatomical Landmarks:
o Mastoid process
o Carotid pulse
o Depression between the two heads of the sternocleidomastoid (above the clavicle)
2. Locate:
o Clavicle
o Two heads of the sternomastoid muscle
3. Needle Insertion:
o Palpate the carotid artery in the center of the triangle formed by the landmarks.
o Insert the needle lateral to the carotid artery.
o Direct the needle at a 45 angle towards the patient in the coronal plane, aiming towards the ipsilateral nipple.
4. Aspirate and Cannulate:
o Aspirate as the needle advances.
o Once blood is aspirated, use the Seldinger technique to cannulate the vein.
5. Secure:
o Suture the line in place.