CVP

Question 1

What are the veins that can be cannulated for a central line (first choice to last and why)?

Answer 1

1. Internal jugular-least chance of pneumothorax, easier to stop arterial bleed, harder to do in awake patient
2. subclavian-higher chance of ptx, harder to stop arterial bleed, easier to do in awake patient
3. femoral-easier to place, less chance for arterial bleed, higher risk of infection, inaccurate cvp
4. median cubital or basillic to axillary- smaller vessel, need 60cm cath

Question 2

1. what does a high cvp with breathlessness, third heart sound, oedema, tender liver mean?
2. there is one defining symptom missing, what is it?

Answer 2

1. heart failure

2. pink frothy sputum from pulmonary edema

Question 3

what does a really high cvp with rapid pulse and muffled heart sounds mean?

Answer 3

pericardial tamponade

Question 4

1. what does a high cvp with asymetrical chest movement, resonant chest, tracheal deviation and rapid pulse mean?
2. what symptom is missing?

Answer 4

1. tension pneumothorax

2. unilateral breath sounds

Question 5

CVP insertion: Internal jugular:

1. where is landmark for insertion?
2. what should you do with your nondominant hand (index finger) before you puncture the internal jugular?

Answer 5

1. between the sternal and clavicular heads of the strernocleidomastoid
2. locate the laryngeal artery just lateral to the cricoid cartilage and keep your finger gently there.

Question 6

cvp insertion: EJV

1. why is this vein sometimes hard to cannulate?

Answer 6

1. there is a valve and the way it joins the subclavian, there is a 10-20% chance it will not pass

Question 7

1. what is the needdle direction when inserting the central line in an internal jugular?
2. at what distance is the vein from the skin?
3. if you do not find the vein at this distance, you should do what?

Answer 7

1. 30-40 degree angle to the skin toward where the nipple is on a man (or without breasts).
2. 2-3 cm (1 inch)
3. move laterally with the needle

Question 8

1. how should head be positioned for upper chest and neck lines?
2. what does this do?

Answer 8

1. head slightly down and turned contralaterally

2. distends venous sinuses and prevents air embolism

Question 9

CL: femoral vein insertion:

1. For what population is this line good for?
2. why is this line not a good line choice for long term?
3. where is the femoral artery in relation to the inguinal ligament?
4. where should the needle be inserted in relation to the pulsation of the femoral artery?
5. what angle should the needle be to the skin
6. at what distance from the skin should the vessel be found

Answer 9

1. children
2. high risk of infection, only should be there for approx 3 days
3. femoral artery is 1-2 cm below the inguinal ligament
4. needle should be inserted 1 cm medial to the femoral artery
5. angle of 20-30 degrees to the skin
6. 2-4 cm from the skin

Question 10

what is different about the placement of a median cubital or basilic vs any other central line

Answer 10

the use of a tourniquet