Exam 4 (US & CVL) Flashcards
What are the contraindications for a CVL?
- Renal cell tumor extending into the right atrium
- Tricuspid valve regurgitation
- Site infection
- Site specific
What are the possible complications of a CVL?
- Pneumo/Hemothorax
- Line-related infections
- Carotid puncture
- Dysrhythmias
- Trauma to nearby nerves
What position is preferred for placing a CVL and why?
- Trendelenburg
- To decrease risk of air embolism & increase venous return
What area is prepped for a CVL?
Chin-sternum-shoulder-neck area
How is the CVL wire inserted?
- In a twisting motion thru the vein needle
- Always hold on to the wire
What are the approximate distances for right SC & IJ CVLs?
- IJ is 15 cm
- SC is 14 cm
What are the approximate distances for left SC & IJ CVLs?
- IJ is 18 cm
- SC is 17 cm
What are the advantages for ultrasounds?
- Identify anatomical structures
- Relationship of needle to tissues
- May decrease time
- May decrease complications
US waves travel at what hertz?
2 - 20 MHz
What structures transmit US waves?
- Fluid
- Anaechoic areas
What structures reflect US waves?
- Bones/stones
- Hyperechoic areas
What frequency do Linear arrays operate in?
7 - 15 MHz
What frequency do Curved arrays operate in?
2 - 5 MHz
What frequency do Phased arrays operate in?
1 - 3 MHz
Phased arrays are good for?
Echocardiography
What is accomplished in static US approach?
- Identifying target vessels
- Assessing patency
- Marking an appropriate insertion site
How do you hold the transducer probe?
Like a pencil
US gain adjusts what?
Quality of the signal coming back to transducer (brightness)
You adjust gain until the fluid is ____ & soft tissue is ___?
- black
- mid-grey
US depth is shown in ____.
centimeters
The axis of a US technique refers to?
The vessel
What axis should one be in for a procedure?
In-plane or long axis
What is the advantage & disadvantage of in-plane?
- Advantage of seeing the needle & tip
- Disadvantage to easily be off plane
What is the advantage & disadvantage of out-of-plane?
- Advantage: Needle is positioned directly under the US plane
- Disadvantage: Unclear where the tip of the needle is
What is the vanishing sign used for?
Determine wether the needle or wire is in the lumen as it moves. Look for bright (hyperechoic)
What are the indications for using FAST?
To rule out free fluid/blood in the abdomen or the pericardium on a trauma Pt
What are the 4 assessment points for FAST?
- RUQ- Morison’s pouch
- LUQ- Peri-splenic view
- Pelvic view- Suprapubic
- Cardiac view
Where is the Morison’s pouch located?
Between the liver & right kidney
What can Heeling and/or Toeing help with?
To maintain parallell alignment
What is the “pop” you feel during an US nerve block?
Entering the fascia
What are the indications for gastric US?
- Lack of adherence to fasting instructions
- Unclear fasting history
- Potential delay in gastric emptying
What will a normal stomach US image look like?
Like a bullseye
What does a grade 1 Antrum mean?
- The stomach contents are < 1.5mL/kg
- The Pt is unlikely to aspirate
What does a grade 2 Antrum mean & how do you proceed?
- The Pt’s stomach contains >1.5 mL/kg of fluid or solid food
- Pt is at risk for aspiration
- RSI or postpone Sx
