Intro to Anes Test3 Flashcards
What prep solution is superior to providone-iodine in reducing skin flora?
0.5% Clorhexidine + 70% alcohol skin prep
Why should you never use 0.5% Clorhexidine + 70% alcohol skin prep for lumbar puncture?
- May be related to previous animal studies
- Higher concentration
- Neurotoxicity
Should you wear masks during Neuraxial blocks? why or why not?
Yes, there are documented meningitis outbreaks in parturients when masks are not worn
Is an Arterial Line insertion a sterile procedure?
No, use aseptic technique, but you should still prep and drape with sterile gloves, sterile field, and sterile catheter.
How should you choose a central line insertion site?
- In order of less likely to get an infection
- Subclavian > neck > femoral
Is a central line insertion a sterile technique?
Yes, use full sterile barrier technique: including gown, gloves, cap and mask
Central Line Dressing should be ____?
Clear, transparent, and adhesive
What should be done before accessing a central line?
- Hand hygiene
- Scrub the hub
How to prevent spreading infection via Laryngoscope blades?
- Keep stored laryngoscope blades covered
- Keep material for materials for next case in clean place, confined and covered
- Blades must be disinfected/sterilized, stored in a way that prevents recontamination, and not stored in an open drawer.
What happens when “Single Use” items are reused?
It imposes liability on the individual and institution for proper function.
Why are Bronchoschopes difficult to disinfect?
Because of their design, fiberoptic materials, channels
Which bacteria is most prevalent in Bronchoscope infections
Pseudomonas outbreaks
How are Bronchoscopes cleaned in between uses
High level disinfection
Double gloving decreases the risk of what?
Needle stick injury
What is a formite
An inanimate object that is contaminated with pathogens and can be a source of spreading pathogens
Ventilator Associated Pneumonia Care Bundle
1) Use Non-invasive ventilation if possible
2) Extubate ASAP
3) In-line subglottic suction, sheathed suction catheters
4) Cuff 20 cm H20
5) Avoid naso-endotracheal route
6) Avoid H2 blockers, PPIs 2° to ↑ aerodigestive bacteria
Epidural Catheters should be removed within what time frame to decrease risk?
48 hours
Difference between Critical items, Semi-critical items and Non-critical items.
1) Critical items - Contact sterile body tissues and needs to be sterilized.
2) Semi-critical items - Contacts mucous membrane and needs high-level disinfection (i.e. laryngoscope blades)
3) Non-critical items - contacts skin and must be cleaned
How do you calculate flow, when talking about the size of IV and tubing?
Pousille’s Law: Q = πR^4p/8nl
How do you troubleshoot pain on injection when dealing with IVs.
- It could be from a misplaced of infiltrated IV
1) Flush IV and look for swelling
2) Don’t use cold fluids
3) Inject lidocaine around the vein
Difference between Infiltration and Extravasation?
1) Infiltration - when the catheter is outside the vein and medication is administered extravascularly but no damage happens.
2) Extravasation - when the catheter is outside the vein and medication is administered extravascularly but har or damage happens.
Which medicines cause the worst damage from extavasation?
Chemo
Examples of medicines that are painful but no cytotoxic if infiltrated?
1) Aminophyllines, amiodarone, calcium solutions, digoxin
2) Mannitol, nitroglycerin, propylene glycol (etomidate, phenytoin, phenobarbital),
3) Tetracyclines, TPN, vancomycin, vasopressin
Complication that can be caused from an Oropharyngeal airway?
1) Macroglossia
2) Lingual nerve palsy
How is an Oropharyngeal airway sized?
Sized from lips to earlobe
When using a Nasopharyngeal airway, what precautions should the CRNA use?
1) use lidocaine jelly (will helpprevent nose bleeds)
2) Bevel faces septum to avoid turbinates
Complications of using Nasopharyngeal airways?
Epistaxis and aspiration of blood
Types of Laryngoscope blades
1) Curved = Macintosh (Designed to engage vallecula and move tongue base and epiglottis forward)
2) Straight = Miller (Designed to scoop under epiglottis and lift it anteriorly)
