Mod VII: ARTERIAL CANNULATION FOR INVASIVE BP MONITORING

Question 1

_{ARTERIAL CANNULATION FOR INVASIVE BLOOD PRESSURE MONITORING}

Indications:

Answer 1

Induced hypotension

Anticipation of wide blood pressure swings

End organ disease necessitating precise beat-to-beat blood pressure regulation

Multiple arterial blood gas samples (or other samples)

Question 2

_{ARTERIAL CANNULATION FOR INVASIVE BLOOD PRESSURE MONITORING}

Contraindications:

Answer 2

Avoid in arteries without documented collateral blood flow

Vascular insufficiency (Raynauds phenomenon)

Question 3

_{ARTERIAL CANNULATION FOR INVASIVE BLOOD PRESSURE MONITORING}

Complications:

Answer 3

Hematoma

Bleeding

Vasospasm

Arterial thrombosis

Air or thrombus emboli

Nerve damage

Infection

Loss of digits

Question 4

_{ARTERIAL CANNULATION FOR INVASIVE BLOOD PRESSURE MONITORING}

Site:

Answer 4

Radial

Ulnar

Brachial

Femoral

Dorsalis pedis and posterior tibial

Question 5

_{ARTERIAL CANNULATION FOR INVASIVE BLOOD PRESSURE MONITORING}

Procedure:

Answer 5

Position

Palpation

Local if awake

20-22 ga catheter over needle at 45 degree angle

Flashback

Lower to 30 degrees

Catheter advanced into artery like an IV

Proximal pressure, connect transducer

Question 6

_{CENTRAL VENOUS CATHETERIZATION}

Indications:

Answer 6

Monitor CVP

Rapid administration of fluid for hypovolemia and shock

Infusion of caustic drugs

TPN

Aspiration of air emboli (cranial surgery)

Venous access for lack of peripheral access

Question 7

_{CENTRAL VENOUS CATHETERIZATION}

Contraindications:

Answer 7

Renal cell tumor extension into the right atrium

Fungating tricuspid valve vegetations

Ipsilateral carotid endarterectomy

Question 8

_{CENTRAL VENOUS CATHETERIZATION}

Complications:

Answer 8

Infection

Air or thrombus emboli

Arrhythmias

Hematoma

Pneumothorax

Hemothorax

Cardiac perforation

Trauma to nearby nerves

Carotid artery puncture

Question 9

_{CENTRAL VENOUS CATHETERIZATION}

Procedure:

Answer 9

Choice of cannulation site: internal jugular(IJV) vs. subclavian vein (SCV)

Trendelenberg position

Full aseptic technique

Bactericidal skin preparation

Sterile drapes

Locate the triangle formed by the two heads of the sternocleidomastoid (STM) muscle and the clavicle

Local if awake

25 ga finder needle for the IJV, along the medial border of the lateral head of the STM, toward ipsilateral breast nipple at an angle of 30 degrees to the skin

Verify as venous blood

18 ga needle in same path as finder, J-wire introduced

Silastic catheter advanced over wire

Guidewire removed

Place thumb over the catheter hub

Connect tubing

Suture

Sterile dressing

Confirmation via CXR