Final- Central Line Principles (7/24/23) Flashcards

1
Q

Where can central lines (central venous catheter) be placed?

A
  • External Jugular
  • Internal Jugular (most common site)
  • Subclavian
  • Femoral
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2
Q

Indications for central lines.

A
  • Monitoring central venous pressure
  • Infusion of caustic drugs
  • Administration of TPN
  • Aspiration of air emboli (wishful thinking)
  • Insertion of transcutaneous pacing leads
  • Venous access for people w/ poor peripheral veins
  • Dialysis access
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3
Q

Contraindications for central lines.

A
  • Renal cell tumor extending into the right atrium
  • Tricuspid valve vegetation
  • Site infection
  • Site specific
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4
Q

Where do most central lines terminate at?

A
  • Cavoatrial Junction
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5
Q

The complications of a central line.

A
  • Pneumothorax/Hemothorax
  • Line-related infection
  • Carotid puncture
  • Dysrhythmias
  • Trauma to nearby nerves
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6
Q

What are the landmarks for placing a central line in the Internal Jugular Vein?

A
  • The needle should be inserted at the triangle’s apex formed by the sternocleidomastoid muscles: sternal head and clavicular head.
  • From the apex, aim at the ipsilateral nipple (same side), and insert the needle 45 degrees into the skin.
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7
Q

Pt. Positioning for Central Line in the Internal Jugular Vein.

A
  • Trendelenburg to decrease the risk of air embolism and increase venous return
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8
Q

What areas are prepped if performing a central line on the right internal jugular vein?

A
  • Chin
  • Sternum
  • Shoulder
  • Neck
  • Ear lobe
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9
Q

Where should the drape cover be if performing a central line?

A
  • Head to foot
  • Side to side
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10
Q

What can be used for vein identification if an ultrasound is not available?

A
  • 25 G seeker needle
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11
Q

Pros and Cons of the Pig Sticker

A
  • No catheter; guidewire threaded from the back end of the needle.
  • Pro: minimized movement; all parts stay together
  • Con: No visualization of blood (artery vs. vein)
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12
Q

What kind of motion is used to insert the J-wire?

A
  • Twisting Motion
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13
Q

What should you never do with the J-wire?

A
  • Never let it go of the J-wire when threading it into the patient.
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14
Q

Catheter Distance
Right IJ:
Right Subclavian:
Left IJ:
Left Subclavian:

A
  • Right IJ: 15 cm
  • Right Subclavian: 14 cm
  • Left IJ: 18 cm
  • Left Subclavian: 17 cm
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15
Q

Placement confirmation of central via ______.

A
  • CXR
  • Note catheter tip
  • Make sure there is no pneumothorax, hemothorax
  • No guidewire left behind
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16
Q

What is used to secure a central line?

A
  • Sutures
  • Tegaderm
  • Staples
17
Q

What do you see in the CXR?

A
  • Left hemothorax
  • Note the flat angle of the right lung
18
Q

What do you see in the CXR?

A
  • Right pneumothorax
  • The dark side of the chest is filled with air that is outside of the lung tissue.
19
Q

Where is the Central Line?

A
  • Right IJ
20
Q

Where is the Central Line?

A
  • Left IJ