Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

I&M II > II. CVP Monitoring > Flashcards

II. CVP Monitoring Flashcards

1
Q

Location of CV catheter tip

A

junction of SVC & RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the CV catheter attached to?

A

pressure tubing & transducer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CV catheters measure CVP. CVP is akin to what other two pressures?

A

Right Atrial Pressure & Jugular Venous Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What law explains the changes in venous compliance and their subsequent effects on cardiac output?

A

Frank-Starling Law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In healthy individuals, venous return is correlated to ____.

A

cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

8 indications for CVC

A
  1. IV access (pts with poor peripheral access)
  2. Infusion of caustic substances
  3. CVP monitoring
  4. Venous blood sampling
  5. Aspiration of VAE
  6. Advanced hemodynamic monitoring
  7. Extracorporeal Therapies (ECMO, CRRT)
  8. Access point for other modalities

HINT: CHASEE

Caustic Substances, Hemodynamic Monitoring, Access Point, Sampling (blood), Embolism aspiration, ECMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Examples of caustic infusion substances:

A
  • NE, Dopamine
  • IV nutrition (TPN)
  • Chemo
  • Prolonged antibiotics
  • Renal replacement therapy, plasmapheresis, or apheresis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Examples of advanced hemodynamic monitoring

A
  1. PICCO(Pulse index Continuous Cardiac Output)
  2. CVO2
  3. PA Catheter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Other modalities that may use CVC as access point (3)

A
  1. IVC filter replacement
  2. Venous Stenting
  3. Transvenous Pacing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

C/I for CVC placement

A
  1. Infection
  2. SVC syndrome
  3. Thrombus of target vessel
  4. Patient intolerance
  5. Coagulopathy
  6. New Pacemaker wires
  7. Some providers avoid on side of previous CEA

HINT:TWIICS

Thrombus, Wires (pacemaker), Intolerance, Infection, Coagulopathy, SVC Syndrome

CHASE TWIICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Thresholds for coagulopathy C/I for CVC placement

A

INR > 1.5

PLT<50,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of CVC

A
  1. Erroneous Data, Misinterpretation, or Misuse of equipment
  2. Arrhythmia (PVCs)
    3..Other
    - Thrombophlebitis
    - Pericardial effusion / Cardiac tamponade
    - Chylothorax (more common with Left IJ & SCV approaches)
    - Tracheal injury
    - Direct nerve injury
    • Brachial plexus,
    • stellate ganglion,
    • phrenic nerves all close to IJ

HINT: MATTT

Misuse/Misinterpretation, Arrhythmia, Thrombophlebitis, Tamponade, Tracheal Injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

____ ga or smaller “finder needle”
Not problematic with normal coagulation

A

22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

____ ga or larger introducer needle
Risk for hematoma, hold pressure 5+ min

A

18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Large bore introducer
If accidentally dilated, hold pressure for ____ min!

A

30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If CVC placed in artery, what should we do?

A

leave it in & get vascular consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Localized hematoma may expand → ____

A

airway compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sights of CVC placement

A
  1. Right & Left IJ
  2. Subclavian
  3. EJ
  4. Femoral
  5. Antecubital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Can be easily visualized with ultrasound
Most direct route to heart
Straight in-line course to right atrium

A

RIGHT Internal jugular vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CVC placement site

Angled course through brachiocephalic vein
Increased risk of chylothorax (thoracic duct injury) → lymphatic fluid (chyle) accumulates in the pleural cavity

A

Left IJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Subclavian has a ____ success rate compared to IJV

A

lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Subclavian has what advantages compared to IJ

A

Better tolerated by patient
↓risk of infection
Can be performed on pt. in cervical collar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Subclavian has what complications compared to IJ?

A

-Greatest risk of pneumothorax
-Also Hemothorax / Mediastinal hematoma
(Chylothorax risk similar to LIJ)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What central venous catheter placement site is both superficial, has a minimal risk of pneumothorax and has a low success rate?

A

External jugular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the approximate success rate of placing an external jugular central venous catheter?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What central venous catheter location is uncommon for intraoperative monitoring, but has a high success rate?

A

Femoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Femoral, central venous catheter placement may be necessary in patients with what type of complication?

A

Superior vena cava obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Antecubital placement involves which two veins potentially?

A
  1. Basilica
  2. Cephalic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which central venous catheter placement, location is used for peripherally, inserted, central, venous, catheters, or PICC lines?

A

Antecubital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Antecubital placement will exhibit lower/higher central, venous pressures.

A

Slightly higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the available sizes of central venous catheters?

A

7.5 - 9.0 Fr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What size lumens are available for central venous catheters?

A

1-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the various lengths for CVC?

A

12-24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What two types of materials are CVC composed of?

A
  1. Silicone.
  2. Polyurethane.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

CVC can have what three types of coatings?

A
  1. Antimicrobial. (chlorhexidine based.)
  2. Heparin.
  3. Radiopaque (confirms tip placement.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the four types of CVC catheters? I

A
  1. Non-tunneled central catheters.
  2. Tunneled central catheters.
  3. Peripherally inserted central catheters (PICC)
  4. Implantable ports.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the most common type of catheter used in the hospital setting?

A

Single lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the most common type of CVC used by Anesthesia personnel?

A

Triple lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the two considerations made when determining length of CVC?

A
  1. Site of insertion.
  2. Patient height.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which port is used for CVP monitoring in a triple lumen catheter?

A

Distal port

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What type of catheter is used as a trauma line with a PA catheter introducer?

A

Large bore triple lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

T/F: all lumens of a triple lumen port can be used for administration of IV solutions and medication.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which port is used for withdrawing blood samples on a CVC triple lumen, why?

A

The proximal port, because it has the least contamination from other infusions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which port on a triple lumen is used for administration of TPN (total parenteral nutrition)?

A

The medial port, because it is safest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Which port is used for blood administration and why on a triple lumen?

A

The distal port, because it is the largest lumen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

List the equipment needed for placement of CVC:

A
  1. Syringe and needle for localanesthetic (1% lidocaine)
  2. Scalpel.
  3. Sterile gel for ultrasound guidance
  4. Introducer needle (18ga) attached to syringe with saline (to detect backflow of blood, upon vein penetration)
  5. Guidewire.
  6. Tissue dilator (8.5 Fr)
  7. Indwelling catheter (16ga)
  8. Additional fasteners, suture and needle
  9. Sterile dressing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What position can patients be placed in in order to increase jugular vein, size with hydrostatic pressure in order to reduce placement difficulty?

A

Trendelenburg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What physical locations on the patient should be prepped with chlorhexidine?

A

Earlobe to sternal notch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

The internal jugular vein is positioned ____ and ____ to the carotid artery.

A
  • Lateral
  • Slightly anterior
50
Q

What landmarks are we looking for when locating the entry point for the right internal jugular vein?

A

The triangle formed by the sternocleidomastoid muscle and clavicle.

51
Q

After the triangle has been identified During identification of the right internal jugular vein, what are the next steps for catheter placement?

A
  1. Palpate carotid pulse.
  2. Enter at Apex of triangle, lateral of carotid, pulse, and aiming at ipsilateral nipple. (30-45 degree angle of entry)
  3. The vein is usually 3 to 5 cm from the skin surface.
52
Q

Which of the two methods is preferred when placing a subclavian central veinous cat catheter?

A

Infraclavicular is preferred

53
Q

How should the patient be positioned when preparing for an infraclavicular subclavian CVC?

A
  1. Supine, head, neutral, arm abducted.
  2. Trendelenburg (10-15º)
  3. Shoulders, neutral with mild retraction.
54
Q

Describe the steps of placement for subclavian CVC:

A
  1. Index finger on suprasternal notch.
  2. Thumb on Costoclavicular junction.
  3. Enter the skin about 1 cm inferior to the clavicle.
  4. Aiming towards index finger, posterior to clavicle, with needle parallel to the skin.
55
Q

During CVC placement, insert and advance the needle while ____.

A

Continuously aspirating

56
Q

Follow the needle tip into the vessel using ____ to confirm.

A

Ultrasound, guidance

57
Q

Successfully cannulate the vessel, and ensure free return of ____ blood.

A

Dark red, non-pulsatile

58
Q

After calculating the vessel and visualizing return of dark, red, non-pulsatile blood, what is the next immediate step?

A

Sit down the probe, and stabilize the needle with left hand. Disconnect the syringe, without changing angle of needle.

59
Q

After removing the syringe from the catheter, what should be done next?

A

Insert the guidewire through the needle to a depth of 20 cm.

60
Q

What should we watch for while inserting the guidewire through the catheter?

A

Ectopy on the ECG (often a run of PVCs)

61
Q

After the guidewire has been inserted, what should we do next?

A

Remove the needle while maintaining control of the guidewire. Then confirm the guidewire is in the vessel using ultrasound.

62
Q

Steps for dilating, the vessel and tissue:

A
  1. Make a small incision adjacent to the guidewire (scalpel)
  2. Advance the dilator over the guidewire and into the skin with the twisting motion while maintaining control of the guidewire.
  3. Ensure the guidewire moves freely within the dilator, then remove the dilator.
63
Q

Once the dilator has been placed, what do we do next?

A
  1. Advance the catheter over the guidewire, using Seldinger’s technique into the vessel to the appropriate depth.
  2. Remove the guidewire.
  3. Aspirate and flush each lumen.
  4. Place capless valves.
64
Q

Which port should be kept covered while removing the guidewire in order to prevent air entry?

A

The brown port

65
Q

What is used to confirm catheter position at the end of procedure?

A

X-ray

66
Q

Ideal placement location of a central venous catheter

A
  1. Distal and within the superior, vena cava, above the right atrium.
  2. Below inferior border of clavicles.
  3. T4 to T5 interspace
  4. At the level of carina
67
Q

How to perform a jugular occlusion test

A
  1. Apply external pressure on the internal jugular vein for 10 seconds and observed change in central venous pressure.
  2. Increased central venous pressure 3 to 5 mm of mercury, indicate a misplaced catheter into the internal jugular vein. 
68
Q

Normal range of central venous pressure during SV

A

0-5 mmHg

69
Q

Normal range of central venous pressure during mechanical ventilation

A

5-10 mmHg

70
Q

T/F: central, venous pressure is used as a guide for fluid therapy

A

True

71
Q

T/F: central, venous pressure, does not always reflect intravascular volume

A

True

72
Q

Wow, there is no target central Venus pressure, a drop in Venus pressure by ____ mmHg indicates fluids may be effective.

A

3-5 mmHg

73
Q

What may occur if we exceeded normal central venous pressure values?

A

Pulmonary and tissue edema

74
Q

1 cmH2O = ____ mmHg

A

1.3

75
Q

CVP ____ with increased venous tone (i.e., SNS stimulation)

A

Increases

76
Q

Decreased compliance will ____ volume and ____ pressure.

A
  • decrease
  • increase
77
Q

Decreased cardiac output ____ CVP due to ____ volume in venous system.

A
  • increases
  • increased
78
Q

Changing from standing to supine body posture ____ CVP.

A

Increases

due to increased volume

79
Q

Arterial dilation ____ CVP.

A

Increases

due to increased volume

80
Q

Forced expiration ____ CVP due to ____.

A
  • increases
  • decreased compliance
81
Q

Muscle contraction ____ CVP due to ____ volume & ____ compliance.

A
  • Increases
  • increased
  • decreased
82
Q

A CVP A wave corresponds to ____, and occurs in ____.

A
  • Right atrial contraction
  • End Diastole (after P-wave on ECG)
83
Q

A CVP C-wave corresponds to ____ and occurs during ____.

A
  • Right ventricular contraction
  • Early Ventricular systole (always follows R wave of ECG)
84
Q

The CVP ____-wave is caused by bulging of the tricuspid valve into the atrium.

A

C

85
Q

The X descent wave indicates ____.

A

Atrial relaxation downward movement of the ventricle

occurs during ventricular systole

86
Q

The V-wave signifies ____

A

Atrial filling against a closed tricuspid valve

occurs during late ventricular systole

HINT:Villing against Valve

87
Q

The Y-descent wave indicates:

A
  • tricuspid valve opening, and bullet quickly entering the ventricle.

occurs during early ventricular diastole

88
Q
  • increased resistance to ventricular filling
  • Increased atrial contraction

The preceding to physiological changes will result in what CVP manifestation?

A

Elevated A waves (“Cannon A Waves”)

Causes: heart failure, tricuspid stenosis, atrioventricular disassociation (Junctional rhythms, AV dissociation, PVCs)

89
Q

Which two waves are the descent waves

A

X & Y

90
Q

Sequential Cannon A Waves can be observed in what syndrome?

A

Pacemaker Syndrome

91
Q

Elevated V Waves (higher than A waves) often have what physiological cause?

A

Tricuspid Regurgitatant flow (against a already contracting right atrium = increased pressure)

  • tricuspid regurgitant flow due to heart failure*
92
Q

SV causes ____ intrathoracic pressure = ____ CVP

A

Decreased

Decreased

93
Q

PPV causes ____ ITP = ____ CVP.

A

increased

Increased

94
Q

CVP should always be read at ____

A

End-expiration

95
Q

Every 5 cmH2O PEEP will increase CVP ____ mmHg

A

~2 mmHg

but will decrease true filling volumes

96
Q

RV compliance is represented as what mathematically

A

V/P

97
Q

T/F: cardiac filling pressures estimate cardiac filling volumes.

A

True

98
Q

T/F: CVP alone is an excellent indicator of volume status.

A

False

CVP is most useful as a trend rather than an absolute value

99
Q

other sites of CVP cannulation picture

A
100
Q

CVC Triple Lumen Picture

A
101
Q

Equipment needed for CVP placement picture

A
102
Q

Equipment for CVP Placement Picture 2

A
103
Q

Ultrasound Supine vs Trendelenberg Picture

A
104
Q

Ultrasound planes comparison picture

A
105
Q

Right IJ Triangle Placement Picture

A
106
Q

CVC placement depth Table Picture

A
107
Q

CVP pressures throughout body Picture

A
108
Q

CVP Interpretaion Picture

A
109
Q

Normal CVP & ECG Waveform Picture

A
110
Q

A-Wave (Atrial Contraction) Picture

A
111
Q

C-Wave (AV Closes) Picture

A
112
Q

X-Descent Wave (Atrial Relaxation) Picture

A
113
Q

V-Wave (Atrial Filling) Picture

A
114
Q

Y-Descent Wave ( AV Valve Opens) Picture

A
115
Q

Cannon A Wave & PVC Picture

A
116
Q

Pacemaker Syndrome Picture

A
117
Q

Elevated V Waves Picture

A
118
Q

Abnormal CVP Waveform Conditions Picture

A
119
Q
A
120
Q

Spontaneous Ventilation CVP waveform picture

A
121
Q

Mechanical Ventilation CVP Waveform Picture

A

I&M II (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions