Test 2 Flashcards
What is the primary advantage of using sonographic guidance during access procedures?
A) It reduces the need for anesthesia
B) It provides real-time imaging throughout the exam
C) It eliminates the need for imaging altogether
D) It speeds up the procedure significantly
B) It provides real-time imaging throughout the exam
Which of the following is a common use of sonographic guidance?
A) Determining blood type
B) Localizing fluid collections
C) Measuring bone density
D) Conducting a stress test
B) Localizing fluid collections
What is a critical aspect of sonographic guidance during needle or catheter placement?
A) It requires prior x-ray imaging
B) It ensures accurate localization of the target
C) It involves patient sedation
D) It is only used for large masses
B) It ensures accurate localization of the target
During a sonographic-guided procedure, what is the typical role of the ultrasound technician?
A) To perform the surgery
B) To provide anesthesia
C) To assist in imaging and needle guidance
D) To analyze laboratory results
C) To assist in imaging and needle guidance
Which of the following is NOT a benefit of using sonographic guidance for access procedures?
A) Increased precision in placement
B) Decreased risk of complications
C) Higher cost compared to other imaging methods
D) Immediate feedback on needle position
C) Higher cost compared to other imaging methods
What are some indications for access procedures?
Diagnostic tool confirming and differentiating pathology
Non surgical intervention such as radiation or chemotherapy
Fluid aspiration (diagnostic or Therapeutic purposes)
What are some contradictions for access procedures?
Uncorrectable coagulopathy
Unsafe route
Uncooperative patient
What is the recommended fibrinogen level according to the Society of Interventional Radiology (SIR)?
A) 100-150 mg/dL
B) 150-200 mg/dL
C) 200-250 mg/dL
D) 250-300 mg/dL
B) 150-200 mg/dL
What is the minimum platelet count recommended by SIR?
A) 30,000-50,000 per microliter
B) 50,000-100,000 per microliter
C) 100,000-150,000 per microliter
D) 150,000-200,000 per microliter
B) 50,000-100,000 per microliter
According to SIR, what is the target Prothrombin Time (PT) value?
A) 1.0-1.5 times baseline
B) 1.5-2 times baseline
C) 2.0-2.5 times baseline
D) 2.5-3.0 times baseline
B) 1.5-2 times baseline
What is the target range for Activated Partial Thromboplastin Time (aPTT) according to SIR?
A) 1.0-1.5 times baseline
B) 1.5-2.5 times baseline
C) 2.5-3.5 times baseline
D) 3.5-4.5 times baseline
B) 1.5-2.5 times baseline
What is the recommended International Normalized Ratio (INR) range for Prothrombin Time (PT) according to SIR? A) 1.0-1.5
B) 1.5-2.0
C) 2.0-2.5
D) 2.5-3.0
B) 1.5-2.0
What are three types of vascular access?
- Peripheral IV
- Central lines
- Arterial access
Where should the tip of a central line be located for optimal placement?
A) Inferior vena cava, superior vena cava, or right atrium
B)Subclavian vein
C) Radial artery
D) Femoral artery
A) Inferior vena cava, superior vena cava, or right atrium
Which of the following sites is NOT commonly used for central line placement?
A) Subclavian vein
B) Internal jugular vein
C) External jugular vein
D) Dorsalis pedis artery
D) Dorsalis pedis artery
What is the primary purpose of a central line?
A) To monitor blood pressure
B) To administer medication and fluids directly into the central venous system
C) To draw arterial blood gases
D) To perform imaging studies
B) To administer medication and fluids directly into the central venous system
Which anatomical region is typically accessed for central line placement in the upper extremity?
A) Femoral region
B) Popliteal region
C) Axillary region
D) Abdominal region
C) Axillary region
What is a potential complication of central line placement?
A) Headache
B) Infection
C) Skin rash
D) Nausea
B) Infection
How does the needle appear, in the plane or long access?
Needle appears an a hyperechoic line
How does the needle appear when out of plane or short access?
Needle appears as a Hyperechoic dot
T/F Needle should be in the same plane as the transducer
True
Artery or Vein?
Tubular fluid filled structures?
Both
Artery or Vein?
High velocity tri-phasic waveform
Artery
Which has the most Hypoechoic walls Artery or Vein?
Veins
Which is more compressible Artery or Vein?
Vein
Which has Anechoic lumen Artery or Vein?
Both
Static guidance, put steps in order:
X marks the spot
Ultrasound used to locate and evaluate target structure
The procedure is then completed without additional sonographuc imaging
The skin is marked according to its location
Ultrasound used to locate and evaluate the target structure
The skin is marked according to it’s location
The procedure is then completed without additional sonographic imaging
“x marks the spot”
Static or dynamic?
Real time guidance
Dynamic
Static or dynamic?
X marks the spot
Static
Static or dynamic?
Sonography used full time
Dynamic
What factors should be evaluated when considering a vessel for access?
A) Color and temperature
B) Size, accessibility, valve, and adjacent artery locations
C) Length and diameter
D) Skin elasticity and hydration
B) Size, accessibility, valve, and adjacent artery locations
How can imaging be optimized to improve access?
A) By increasing the power of the ultrasound machine
B) By using lower-frequency transducers
C) By choosing an angle that allows safe access
D) By adjusting the room temperature
C) By choosing an angle that allows safe access
What is a critical consideration to avoid complications during access?
A) Puncturing only superficial veins
B) Ensuring an approach that avoids hitting an artery if the posterior venous wall is punctured
C) Using a larger gauge needle
D) Performing the procedure without imaging
B) Ensuring an approach that avoids hitting an artery if the posterior venous wall is punctured
TF Sterile procedure only require one operator for sonography
F another person is needed for image adjustments
Name four drainage procedure
- Percutaneous drainage of fluid collections
- Percutaneous nephrostomy tube
- Paracentesis
- Thoracentesis
Does gel go inside or outside of the probe cover in a sterile procedure? Why?
What does an air bubble do to the image?
Hyperechoic artifact with posterior shadow
What is the purpose of Percutaneous drainage?
To remove infected fluid from the body
Does abscess drainage come before or after antibiotics?
After antibiotics have failed
Can drains be placed after percutaneous drainage?
Yes. Depending on the size and location. A drain might be placed or a syringe used. Fluid is usually sent for cultures in the lab.
What is the primary clinical indication for placing an indwelling catheter in the collecting system of the kidney?
A) Routine urinary monitoring
B) Urinary tract obstruction
C) Treatment of urinary incontinence
D) Diagnosis of kidney stones
B) Urinary tract obstruction
Which imaging modalities can be used for guidance during the placement of an indwelling catheter?
A) X-ray and CT scan
B) MRI and PET scan
C) Ultrasound and fluoroscopy
D) Plain radiography and nuclear medicine
C) Ultrasound and fluoroscopy
What position are patients typically placed in during the procedure for catheter placement?
A) Supine
B) Sitting
C) Prone or lateral
D) Trendelenburg
C) Prone or lateral
Why are coagulation studies required before placing an indwelling catheter?
A) To assess kidney function
B) To evaluate the need for antibiotics
C) To ensure normal blood clotting
D) To determine the type of catheter needed
C) To ensure normal blood clotting
How long before the procedure are patients often administered IV antibiotics?
A) 12-24 hours
B) 6-12 hours
C) 1-4 hours
D) 24-48 hours
C) 1-4 hours
What anesthetic is used for nephrostomy tube placement?
Lidocaine
What size is the initial puncture needle for nephrostomy tube placement?
18-22 gauge
What size is the guide wire for nephrostomy tube placement?
0.018 or .038 inch
What type of drain is used for nephrostomy tube placement?
Pigtail drain usually 8f
Is nephrostomy tube placement a sterile or no sterile procedure?
Sterile
When should images be taken during the procedure for catheter placement?
A) After establishing a sterile field
B) Before establishing a sterile field
C) After the catheter is in place
D) During the administration of numbing medication
B) before establishing a sterile field
When should images be taken during the procedure for catheter placement?
A) After establishing a sterile field
B) Before establishing a sterile field
C) After the catheter is in place
D) During the administration of numbing medication
B) before establishing a sterile field
What is the purpose of cleaning and draping the area before the procedure?
A) To minimize discomfort
B) To ensure proper imaging
C) To establish a sterile field
D) To prepare for anesthesia
C) to establish a sterile field
Which step is taken immediately after administering numbing medication?
A) Cleaning the area again
B) Inserting the guidewire
C) Advancing the needle to the calyx
D) Sending urine samples for labs
C) advancing the needle to the calyx
What is used to anchor the drain to the skin?
A) A bandage
B) A stitch and adhesive
C) Sterile tape
D) A skin glue
B) a stitch and adhesive
How often should indwelling catheters be changed?
A) Every month
B) Every 6 weeks
C) Every 3 months
D) Every 6 months
C) every 3 months
Complications and risks of Percutaneous nephrostomy tube placement?
Complications and risks:
Bleeding
Pneumothorax
Bowel injury and peritonitis
Urine leak
Splenic or liver injury
Catheter obstruction or displacement
Is static or dynamic guidance used more often for Paracentesis?
Static
Purpose of Paracentesis?
Remove ascitis from the abdomen
Paracentesis is diagnostic or therapeutic?
Both
Clinical indications for Paracentesis?
A) cirrhosis
B) malignancy
C) heart failure
D) TB
All of the above, dialysis and pancreatic disease are also indicators
What method is used to indicate the approach on the skin after localizing it with ultrasound?
A) Ink tattoo
B) Marker or indenting
C) Surgical incision
D) Digital palpation
B) marker or indenting
What is the first step taken after marking the location on the skin?
A) Advancing the needle
B) Cleaning and draping the area
C) Administering local anesthetic
D) Applying a bandage
B) cleaning and draping the area
What local anesthetic is typically used to numb the marked location?
A) Bupivacaine
B) Procaine
C) Lidocaine
D) Ropivacaine
C) lidocaine
What happens to the fluid collected during the procedure if it is deemed diagnostic?
A) It is discarded immediately
B) It is tested
C) It is stored for future use
D) It is injected back into the patient
B) it is tested
What is done at the end of the procedure after the catheter is removed?
A) The site is sutured
B) A dressing is applied
C) Antibiotics are administered
D) The patient is sent for imaging
B) a dressing is applied
How much fluid needs to be removed in Paracentesis to require albumin replacement?
5L
Paracentesis complications
Complications
Post-procedure leaking (z-track to minimize)
Circulatory collapse/hepatorenal syndrome (minimized with albumin replacement)
Bleeding
Infection
Bowel perforation
What are the steps of Paracentesis? (4)
- Mark the skin
- Pull the skin down
- Insert the needle perpendicular to the skin and aspirate
- Withdraw the needle and release the skin
List equipment for Paracentesis
60 mL syringe
10 mL syringe
Lidocaine
Needle with catheter
specimen tubes
22 gauge needle
25 gauge needle
Scalpel
Large volume collection tubing
What procedure is similar to paracentesis but involves draining pleural fluid?
A) Thoracentesis
B) Pleurodesis
C) Chest tube insertion
D) Mediastinoscopy
A) thoracentesis
In what position should the patient ideally be during the drainage of pleural fluid?
A) Supine
B) Prone
C) Upright
D) Lateral
C) upright
What areas of the body are typically accessed to drain pleural fluid?
A) Abdomen
B) Intercostal spaces of the posterior chest
C) Anterior chest
D) Neck
B) intercostal spaces of the posterior chest
What are the two main purposes of performing a thoracentesis?
A) Cosmetic improvement and monitoring
B) Diagnostic and therapeutic
C) Pain relief and patient comfort
D) Surgical intervention and imaging
B) diagnostic and therapeutic
Which condition would contraindicate performing a thoracentesis?
A) Mild respiratory disease
B) Intractable coughing
C) Chest pain
D) Low-grade fever
B) interactable coughing
How is the fluid typically removed during the thoracentesis procedure?
A) Using suction
B) By drainage bag without suction when possible
C) Manually with a syringe
D) Through a catheter system
B) by drainage bag without suction when possible
Thoracentesis complications
Complications
Pain
Cough
Vasovagal reaction
Re-expansion pulmonary edema
Pneumothorax
Hemothorax
Infection
What is the primary use of endovaginal procedures?
A) To assess breast tissue
B) To evaluate the uterine cavity and endometrium
C) To examine the abdominal organs
D) To diagnose pelvic inflammatory disease
B) to evaluate the uterine cavity and endometrium
Which of the following is a common indication for performing an endovaginal procedure?
A) Chest pain
B) Fertility concerns
C) Liver dysfunction
D) Skin lesions
B) fertility concerns
What condition might be assessed using endovaginal procedures in postmenopausal women?
A) Ovarian cysts
B) Uterine prolapse
C) Postmenopausal bleeding
D) Vaginal infections
C) post menopausal bleeding
Which of the following can be an indication for an endovaginal procedure?
A) Cystitis
B) Submucosal fibroids
C) Hyperthyroidism
D) Osteoporosis
B) submucosal fibroids
Which of the following can be an indication for an endovaginal procedure?
A) Cystitis
B) Submucosal fibroids
C) Hyperthyroidism
D) Osteoporosis
B) submucosal fibroids
Which of the following is a contraindication for performing an endovaginal procedure?
A) Heavy menstrual bleeding
B) Pregnancy
C) Previous pelvic surgery
D) Mild abdominal pain
B) pregnancy
Why is the presence of an IUD considered a contraindication for endovaginal procedures?
A) It may cause excessive bleeding
B) It can interfere with imaging
C) It may increase the risk of infection
D) It may displace during the procedure
D) it may displace during the procedure
What day of the menstrual cycle should sis be preformed?
4-7
Should endovaginal ultrasound be preformed before or after SIS?
Before
What position should patient be in for SIS?
Lithotomy
What instrument is used to locate the cervix?
Speculum
What is used to clean during SIS?
Iodine
When is the balloon inflated during SIS?
Not until your past the cervix
What is the next step after the speculum is removed during SIS?
The endovaginal probe is inserted
What is injected in the catheter during SIS?
Sterile saline
What is the last step of SIS?
Balloon is deflated and catheter is removed
