Sterile Technique & CVC Insertion - Quiz 6 Flashcards
How long should the site be prepped w/ Chlorhexidine?
30 second Friction Rub & Allow 2 minute Air Dry
What are some Contraindications to CVC Placement?
Pt. Refuse
Tricuspid Vegetation
Anatomic Obstruction
SVC Syndrome
Coagulopathy
RA Tumor/Clot
RV Assist Device
Site Infection
Existing Pacing Wires/Catheters
What are the Pre-Procedure Steps?
- Open Kit
- Wash Hands
- Sterile Gown/Glove Up
- CHG Prep & Dry
- Drape
Where are the sites that are appropriate for CVC Insertion?
RIJ
LIJ
Subclavian
Femoral
Brachial
External Jugular
Why is the Right IJ most common & preferred CVC Insertion Site?
Right Pleura not as High
&
Avoids Thoracic Duct
What are the risks of using the RIJ for CVC Placement?
Nerve Damage
Venous Air Embolism
Carotid Artery Puncture
Contamination from Resp. Secretions
What are the risks w/ using the Left IJ for CVC Placement?
Difficult
Nerve Damage
Venous Air Embolism
Carotid Artery Puncture
Pleural Effusion
Chylothorax - lymph leak into pleural space
What are the Pros & Cons of using the Subclavian for CVC Insertion?
Lower Infection Rate, but Higher Pneumothorax risk
What are the complications associated w/ using the External Jugular for CVC Insertion?
Hard to threat d/t Valves
Kinking
Migration
Phlebitis
Arterial Puncture
Why is the Femoral site the last resort for Placing a CVC?
High Risk of CVC-related Sepsis
Placing a CVC at the _______ is difficult and requires a Percutaneous Approach
Placing a CVC at the Brachial is difficult and requires a Percutaneous Approach
Where is the Internal Jugular Vein Located?
B/t the Sternal & Clavicular Heads of Sternocleidomastoid Muscle
&
Lateral to Carotid
What are the steps of Placing a CVC after locating the Apex of the Triangle formed by the two heads of the Sternocleidomastoid Muscle?
- Place Gel & U/S Probe Cover on U/S Probe, Secure w/ Rubber Band
- Visualize Compressible IJ
- Inject 1-2cc Lidocaine 1%
- Place Needle & Advanced towards Ipsilateral Nipple @ 30-45 degree angle while aspirating until bloods flows freely into syringe
What are the steps of Placing a CVC after Blood is freely aspirated into the Syringe?
- Confirm no Pulsation
- Remove Needle, while Leaving Catheter in Place
- Pass Guidewire 6-8 inches, while watching ECG for PVCs
- Remove Catheter, while leaving wire in place
- Make small incision at the wire w/ Scalpel
- Use Dilator over wire & advance 1 inch beyond skin until loss of resistance
- Remove dilator while leaving wire in place
What can cause Venous Blood from the IJ to appear Brighter & Pulsatile?
Shunting can cause venous blood to appear brighter
&
Triscupid Regurg & A-Fib can make CVP appear Pulsatile
