Final - Ultrasound & Central Line Flashcards
Ultrasound waves travel between __ Mhz.
A. 5-15
B. 2-20
C. 10-25
D. 5-20
B. 2-20 Mhz
travel differently in different structures; audible sound is 20-20k Hz
When they encounter a surface, ultrasound waves are either transmitted, reflected, or something in between. What kind of structure is transmitted and what does it look like?
A. fluid; shades of gray
B. bones/stones; anechoic
C. fluid; anaechoic
D. soft tissue/fat; shades of gray
C. fluid; has no signal = anaechoic (dark)
When they encounter a surface, ultrasound waves are either transmitted, reflected, or something in between. What kind of structure is reflected and what does it look like?
A. fluid; shades of gray
B. bones/stones; anechoic
C. soft tissue/fat; anaechoic
D. soft tissue/fat; shades of gray
E. bones/stones; hyperechoic
E. bones/stones; lots of signals = Hyperechoic (Bright)
When they encounter a surface, ultrasound waves are either transmitted, reflected, or something in between. What kind of structure is something in between and what does it look like?
A. fluid; shades of gray
B. bones/stones; anechoic
C. soft tissue/fat; anaechoic
D. soft tissue/fat; shades of gray
E. fluid; hyperechoic
D. soft tissue/fat/muscles; Iso/hypoechoic = Shades of gray
Which picture represents a solid?
Which picture represents fluid?
- Picture A: Solid
- Picture B: Fluid
What’s inside the transducer’s head that change shape with an electric impulse?
A. lube/jelly
B. piezo electric crystals
C. indicator
D. conductive gel
B. Piezo Electric Crystals
these start to vibrate = generates sound waves
Which probe is high frequency, has better resolution, and is used for superficial depth?
A. linear array
B. phased array
C. curvilinear/curved array
A. linear array probe
-High frequency (7-15 MHz)
-Better resolution at a superficial depth
great for IJ central line and IV!
A curved array probe is: select 2.
A. good for superficial depth like IVs
B. low frequency (2-5 MHz)
C. high frequency (7-15 MHz)
D. good for deeper tissues like doing eFAST
B. Low frequency (2-5 MHz) with Poorer resolution
D. Great for deeper tissue like eFAST, bladder, kidneys, gastric
A phased array is useful for:
A. sonography
B. eFAST
C. gastric US
D. echocardiography
D. Useful for echocardiography
Lowest frequency (1-3 MHz)
What is Static vs Dynamic Approach?
A. static approach cannultes blindly while dynamic approach views the needle puncturing vessel wall.
B. dynamic approach cannultes blindly while static approach views the needle puncturing vessel wall.
C. dynamic approach marks an appropriate insertion site
D. static approach performs the procedure in real time
A. Static: Identifying the target vessel, assessing the patency, marking an appropriate insertion site, and cannulating blindly.
Dynamic: Performing the procedure in real-time and viewing the needle puncturing the vessel wall.
What are some tips and tricks for using US? select 2.
A. don’t use any gel since it will be messy
B. keep bed lower to see patient entirely
C. hold transducer probe like a pencil
D. focus by using gain and depth buttons
E. use static approach
C. Hold the Transducer probe like a pencil
D. Focus using gain and depth buttons
Also: use Proper Ergonomics (raise bed, stand straight up to protect back) and use plenty of Conductive gel!!!
T/F: Increasing gain means increasing brightness.
True; gain is the brightness signal quality, adjusted with a knob.
Twist the knob back and forth until fluid is black and soft tissue is mid-grey
T/F: Use depth buttons to keep your margins/entire picture in the top half of the screen.
False; Use depth buttons to keep your margins/entire picture in the MIDDLE of the screen.
depth is shown in cm!!!
In-plane vs. Out-of-plane refers to the relationship of ____ to the ultrasound plane.
A. patient
B. gel
C. needle
D. vessel
C. needle
What is the advantage of in-plane ultrasound?
Disadvantage?
- Advantage: See the whole needle
- Disadvantage: Easy to be off plane
What is the advantage of out-of-plane ultrasound?
Disadvantage?
- Advantage: The needle is positioned directly under the plane of an ultrasound
- Disadvantage: Unclear where tip of the needle is
What do you look for to determine that your guidewire is in the vessel’s lumen?
A. distinguishing sign
B. vanishing sign
C. entire needle thru tissue
D. heeling sign
B. Vanishing Sign
What are common anesthesia uses for ultrasound?
A. guided IV access
B. focused assessment with sonography for trauma
C. ultrasound-guided nerve blocks
D. gastric POCUS
E. all of the above
E. all of the above!
* Guided IV Access
* Focused Assessment with Sonography for Trauma
* Ultrasound-guided Nerve Blocks
* Gastric Ultrasound
What are the indications for using USG IV Access?
- History of difficult cannulation
- Multiple failed attempts
- Best to use a linear probe, if the patient is obese, use the curve probe
What are the contraindications for using USG IV Access?
A. pediatric patients
B. history of difficult cannulation
C. life-threatening situations
D. multiple failed attempts
C. Does not substitute for IO access in life-threatening situations
use linear probe for US guided IVs
Indications to use a FAST include:
A. measure gastric contents
B. r/o free fluid in the abdomen and pericardium
C. US guided IV access
D. bladder scan to measure urine volume
B. r/o free fluid in the abdomen and pericardium
What probe is used for a FAST?
A. linear probe
B. phased array probe
C. curvilinear probe
C. Curvilinear probe
What are the 4 assessment points for FAST in order?
A. RUQ, pelvic, cardiac, LUQ
B. RUQ, pelvic, cardiac, LUQ
C. RUQ, LUQ, cardiac, pelvic
D. RUQ, LUQ, pelvic, cardiac
D.
* (1) RUQ- Morison’s pouch (Liver, Right Kidney)
* (2) LUQ- Peri-splenic view (Spleen, Left Kidney)
* (3) Pelvic view- Suprapubic (Bladder rupture)
* (4) Cardiac view (Pericardial sac)
When performing an USG peripheral nerve block, what can be done to the transducer to maintain parallel alignment with nerve?
A. vanishing sign
B. heeling
C. scanning
D. go to long axis
B. Heeling
What is an indication for a gastric US? select 2.
A. lack of adherance to fasting
B. stomach pain before anesthesia
C. unclear fasting history
D. recent n/v
A. Lack of adherence to fasting instructions
C. Unclear fasting history and/or Potential delay in gastric emptying (like diabetics or ozempic)
Grade the Antrum
- Grade 0 Antrum = Empty Stomach
- Bull’s Eye!!!
Grade the Antrum
- Grade 1 Antrum: < 1.5 ml/kg
- Aspiration Unlikely
Grade the Antrum
- Grade 2 Antrum: > 1.5 ml/kg
- Solid Food = hyperechoic!!
- High Risk of Aspiration!
Which four veins can be used for central venous catheters?
- External Jugular
- Internal Jugular (most common site)
- Subclavian
- Femoral
Indications for central lines.
- 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
What are contraindications for central lines? select 3
A. TPN administration
B. caustic drugs infusion
C. renal cell tumor extending into right atrium
D. site infection
E. air emboli
F. tricuspid valve vegetation
C. Renal cell tumor extending into the right atrium
D. site infection and site specific
F. Tricuspid valve vegetation
Where should central lines terminate?
A. right atrium
B. cavoatrial junction
C. inferior vena cava
D. superior vena cava
B. Cavoatrial Junction
Common complications of a central line include: select 3
A. hemo/pneuthorax
B. MI
C. infection
D. thrombus
E. dysrhythmias
F. syncope
A. Pneumothorax/Hemothorax
C. line-related infection
E. Dysrhythmias
-carotid puncture and trauma to nearby nerves
What are the landmarks for placing a central line in the Internal Jugular Vein?
- 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.
What is ideal pt positioning for Central Line in the Internal Jugular Vein?
A. reverse trendelenberg
B. supine
C. trendelenberg
D. lateral decubitus
C. Trendelenburg (head down) to decrease the risk of air embolism and increase venous return!
What areas are prepped if performing a central line on the right internal jugular vein?
- Chin
- Sternum
- Shoulder
- Neck
- Ear lobe
CSSNE
Where should the drape cover when performing a central line?
- Head to foot
- Side to side
What can be used for vein identification if an ultrasound is not available?
A. 24G seeker needle
B. 22G finder needle
C. 25G seeker needle
D. 24G finder needle
C. 25 G seeker needle
then before/after seeker needle..put catheter over needle
A pig sticker does not have a catheter; instead, the guidewire is threaded from the back end of the needle…What is a Pro and Con of the Pig Sticker? select 2
A. all parts stay together
B. too much movement
C. no visualization of blood
D. blood may shoot out too quick
A. Pro: minimized movement; all parts stay together
C. Con: No visualization of blood (hard to tell if artery vs. vein)
What kind of motion is used to insert the J-wire?
- Twisting Motion
What should you never do when placing a central line?
A. twist the wire in
B. aspirate blood
C. let go of the guide wire
D. knick skin to enlarge opening
C. Never let go of the J-wire when threading it into the patient.
Catheter Distance
Right IJ:
Right Subclavian:
Left IJ:
Left Subclavian:
- Right IJ: 15 cm
- Right Subclavian: 14 cm
- Left IJ: 18 cm
- Left Subclavian: 17 cm
Placement confirmation of CVC via ___.
A. aspiration
B. CXR
C. ultrasound
D. EKG
B. CXR
Note: catheter tip, Make sure there is no pneumo/hemothorax
-AND make sure No guidewire left behind
What do you see in the CXR?
- Left hemothorax
- Note the flat angle of the right lung
What do you see in the CXR?
- Right pneumothorax
- The dark side of the chest is filled with air that is outside of the lung tissue.
Where is the Central Line?
- Right IJ
Where is the Central Line?
- Left IJ
note how it curves from left side to atrial caval jxn
