Procedures

Question 1

Possible complications of IV placement

Answer 1

hematoma
infection

Question 2

Possible complications of an arterial line

Answer 2

arterial occlusion by thrombosis/hematoma
Infection
Ischemia
Hematoma

Question 3

Describe the procedure for arterial puncture (radial)

Answer 3

Allen test to ensure ulnar collateral circulation is adequate
Have someone hold arm with wrist in supination and wrist hyperextended to 20-30 degrees
Using gloves palpate the vessel - can use ultrasound
Cleanse the skin
Pierce skin between index and middle fingers of the palpating hand, directing needle at 30-60 degrees

Question 4

In which patients should femoral punctures not be performed?

Answer 4

coagulation defect
hypercoagulable state
cardiac shunt

Question 5

Possible complications of femoral puncture

Answer 5

hematoma of femoral triangle
thrombosis
superficial infection
osteomyelitis/arthritis of proximal femur, hip joint

Question 6

Where is the femoral artery found?

Answer 6

halfway between the anterior-superior iliac spine and the pubic symphysis

Question 7

Where does the femoral vein lie in relation to the femoral artery?

Answer 7

0.5-1cm medially

Question 8

Possible complications of percutaneous femoral vein catheterization

Answer 8

Inadvertent arterial catheterization
Arterial or venous laceration
Infection
Hematoma
Catheter or wire fragment in central circulation

Question 9

Possible complications of IJ vein catheterization

Answer 9

Inadvertent arterial catheterization
Expanding hematoma
Arterial or venous laceration
Infection
Catheter or wire fragment in central circulation
Pneumothorax, hemothorax
Pneumomediastinum
Cardiac trauma

Question 10

Possible complications of IO insertion

Answer 10

Extravasation of fluids or medications into subcutaneous tissue
Subcutaneous abscess, osteomyelitis, and bacteremia
Physeal injury or fracture
Fat embolus

Question 11

Preferred locations of iO insertion

Answer 11

proximal tibia - flat medial surface 1-2cm below tibial tuberosity
distal femur - lower 1/3 in midline approx 3cm above lateral condyle

Question 12

Procedure for insertion of IO

Answer 12

Lidocaine (if non-emergency)
antiseptic
landmark
insert IO - angle away from the growth plate ~ 10-15 degrees
Remove stylet and attempt to aspirate, if can’t attempt to push fluids and ensure no signs of infiltration
flush needle with heparinized saline + connect to IV tubing

if using EZIO - make sure to attach stabilizer after confirming location and before attaching IV tubing

Question 13

Possible complications of CVCs

Answer 13

CVC-associated infection
Thrombus
Displaced/ruptured/broken catheter
Occlusion
Phlebitis
Cardiac arrhythmias
Infiltration
Infusion of medications that interact with silicone (e.g., phenytoin or diazepam)
Use caution to avoid infusion of incompatible medications

Question 14

Possible complications of LP

Answer 14

Contamination of the CSF sample with blood from the epidural venous plexus
Local back pain—occasionally with short-lived referred limp
Headache (uncommon in children younger than 10 years of age)
Apnea/hypoventilation caused by positioning for the procedure in young infants
Spinal epidural/subdural hematoma or spinal cord bleeding—especially in the presence of bleeding diathesis
Infection
Subarachnoid epidermoid tumor formation
Ocular muscle palsy (transient)
Epidural CSF leak—ranging from asymptomatic to cauda equina syndrome
Brainstem herniation—in the presence of a mass effect or noncommunicating hydrocephalus

Question 15

At what vertebral level does the spinal cord end?

Answer 15

L1+L2

Question 16

Where are the desired sites for LP?

Answer 16

interspace between L3-L4 or L4-L5

Question 17

Possible complications of removing a foreign body from the ear

Answer 17

Abrasion of the external auditory canal
Perforation of the tympanic membrane
Ossicular disruption

Question 18

Methods for removing a foreign body from the ear

Answer 18

Curette
Forceps
Irrigation
Day ear hook
Katz extractor

Question 19

Steps after draining an auricular hematoma

Answer 19

apply pressure for 3-5 mins to tamponade any ongoing bleeding
re-establish normal ear contours with wet cotton and apply a pressure or bolster dressing
arrange for f/u in 12-24hrs

Question 20

How long + how much to irrigate eye if got acid in the eye

Answer 20

minimum 5 mins using at least 1 L

Question 21

How long + how much to irrigate eye if got alkali or unknown substance in the eye

Answer 21

minimum 20 mins using at least 2L

Question 22

When do you stop irrigating the eye?

Answer 22

when neutral pH is achieved

Question 23

Possible complications of nasal cauterization

Answer 23

Septal perforation
Staining of the external nose or upper lip with the use of silver nitrate
Secondary bacterial infection of the cauterized area

Question 24

Contraindications to nasal cauterization

Answer 24

Bleeding diathesis
Prior nasal cauterization in past 4-6 weeks

Question 25

Possible complications of nasal packing

Answer 25

Bacterial rhinosinusitis
Toxic shock syndrome
Nasal alar or columellar necrosis
Septal ulceration or perforation
Synechiae formation
Hypoxemia or respiratory distress from sedation and nasal airway obstruction