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AP I > Vascular Access* > Flashcards

Vascular Access* Flashcards

1
Q

what is the purpose of IV placement?

A

NPO “non per os”
Fluid Loss
Blood Loss
Drug Administration

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2
Q

plasma volume is approx. what?

A

~2 L

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3
Q

what percentage of water is intracellular vs. extracellular?

A 
intracellular = 65%
extracellular = 35%
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4
Q

osmolality

A

the concentration of an osmotic solution per 1000 grams of solvent

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5
Q

osmolarity

A

the concentration of osmotic solution per liter of fluid

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6
Q

normal OSMotic pressure

A

Normal = 285 mOsm/L

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7
Q

normal ONCotic pressure

A 
Oncotic pressure (mmHg) 
Normal = 28 mmHg
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8
Q

Frequently used in place of osmotic pressure or tension, is related to the number of non-penetrating particles found in solution

A

tonicity

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9
Q

Of equal tension. Denoting a solution having the same tonicity as another solution with which it is compared

A

isotonic

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10
Q

Having a higher concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles. A solution in which cells shrink due to efflux of water.

A

hypertonic

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11
Q

Having a lower concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles. A solution in which cells expand due to influx of water.

A

hypotonic

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12
Q

what happens to a RC in a hyper-, hypo-, and isotonic solution?

A 
hypertonic = shrinks
hypotonic = swells
isotonic = nothing
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13
Q

what are the normal plasma values for Na+ and K+?

A

135-145

3.5-5.0

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14
Q

which commonly given fluid contains Ca2+ and why does that matter?

A

LR

Ca2+ can start the coagulation cascade

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15
Q

what dictates whether the solution should be delivered via the peripheral or central venous route?

A

The tonicity of an IV fluid
Extremely hypotonic and hypertonic solutions may be infused in small volumes and into large vessels, where dilution and distribution are rapid.

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16
Q

The generally accepted upper limit for a peripheral IV is ______ mOsm/L

A

900

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17
Q

T or F: K+ can be given peripherally

A

FALSE

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18
Q

in normal adults, what is the average daily fluid loss?

A

Total ~2500 ml/day

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19
Q

4-2-1 Rule

A 
Example: 70kg pt
4ml/kg/hr*10kg = 40 ml/hr
2ml/kg/hr*10kg = 20 ml/hr
1ml/kg/hr*50kg = 50 ml/hr
		       	70kg = 110 ml/hr
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20
Q

what is the Sensible Fluid Loss Perioperative for minor, moderate and major surgery?

A

2-4 ml/kg/hr minor surgery (hernia)
4-6 ml/kg/hr moderate surgery (chole)
6-10 ml/kg/hr major surgery (bowel resection)

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21
Q

Replace 1mL blood loss with ___mL crystalloid or ___mL colloid

A

3

1

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22
Q

Monitor vitals and maintain urine output at a MINIMUM _____ml/kg/hr

A

0.5

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23
Q

fluid calculation

A 
Hysterectomy 70 kg Female
NPO Deficit 10 hrs = 1100 ml NS
Maintenance 110 ml/hr
Blood loss = 300 = 900 ml NS
Sensible loss 4 ml/kg/hr = 280 ml/hr
Total case 3 hours = 1100+330+900+840 = 3170 ml
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24
Q

how much blood can a 4x4 and lap pad hold?

A

Surgical sponge (4x4)
10mL blood
“Lap pads”
100-150mL blood

25
Q

Aqueous solution of low MW ions with or without glucose

Examples: NS, Lactated Ringers, Plasma-Lyte

A

crystalloid

26
Q

Aqueous solution of high MW substances
Maintain plasma colloid oncotic pressure
Albumin, Hetastarch, etc.

A

colloid

27
Q

Intravascular halflife of crystalloids is

A

20-30min

28
Q

advantages/disadvantages of crystalloids and colloids

A

CHART

29
Q

A potential complication of giving too much Normal saline is what?

A

Hypochloremic metabolic acidosis

30
Q

which fluid can lower Na levels?

A

LR

31
Q

when would you give 3% and 7.5% NaCl?

A

Severe hyponatremia or hypovolemic shock

32
Q

how much fluid should be given in the first hour?

A

half of NPO deficit + maintenance

33
Q

what are some potential side effects of dextran?

A

coagulopathy, renal dysfunction, anaphylaxis, osmotic diuresis

34
Q

what is normovolemic hemodilution?

A

take blood out of pt before a case and give it back at the end

35
Q

how do you calculate EBL?

A

[(Hcti-Hcta) / Hct avg] x EBV = ABL

36
Q

For each unit of PRBC transfused you can expect the HCT to increase by ___% or Hgb to increase by ____ g/dl

A

3%

1

37
Q

transfusion is rarely indicated when the hemoglobin concentration is greater than ____ g/dL and is almost always indicated when it is less than ___ g/dL, especially when anemia is acute

A

10

6

38
Q

when and how would you administer PRBC?

A

Admin pt. who require RBC but no volume
Carefully checked against blood slip and patient ID
Transfusion w/170 micron filter
Blood warmed prior to infusion

39
Q

when is the Rh system particularly important?

A

in childbearing women, can cause reactivity between mom and baby

40
Q

which blood compatability test is more sensitive and which test is for antibodies?

A

type and cross = sensitive

type and screen = antibodies

41
Q

what is the universal donor?

A

O-

42
Q

what blood product do you not warm?

A

platelets

43
Q

when is a platelet transfusion recommended?

A

Plt < 50k increase Sx blood loss
Oncology Pt >10,000/mm3
Target > 100k/mm3
Each unit increases 5-10k/mm3

44
Q

which transfusion product is associated with hemophelia pts?

A

Cryopercipitate

45
Q

what blood product are you most likely to see a reaction/complication from and why?

A

platelets—multidonor

46
Q

what is the most common non-infectious reaction to blood products?

A

fever

47
Q

what do AHTR and TRALI stand for?

A

Acute Hemolytic Transfusion Reaction

Transfusion Related Acute Lung Injury

48
Q

three most common site for arterial cannulation?

A

radial
femoral
brachial

49
Q

what does Allen’s test check for?

A

collateral circulation

50
Q

what sites are contraindicated in patients with Raynaud’s Syndrome for art lines?

A

radial and ulnar

51
Q

what is Raynaud’s syndrome?

A

constriction of vessels decreases blood supply to the fingers

52
Q

which artery is prone to pseudoaneurysm and atheroma formation as documented following cardiac catheterization. It also has an increased incidence of infection.

A

femoral

53
Q

when would you need to gain central venous access?

A 
Monitoring central venous pressure
Fluid administration
Infusion of caustic Rx
TPN (total parenteral nutrition)
Air emboli aspiration
Transcutaneous pacing leads
Poor peripheral access
54
Q

what are some contraindications for central venous access?

A

R atrial tumors
Fungating tricuspid valve vegetations

Contraindications relative to site:
Local sepsis
Previous vessel damage
Suspected injury to IVC or SVC

55
Q

What are some common sites for central venous access?

A

Femoral vein
External jugular
Internal jugular*
Subclavian vein

56
Q

what is Seldinger’s Technque?

A

when you thread a catheter over a wire

57
Q

potential complications from central venous access

A 
Pneumothorax/hemothorax 
Air embolism
Arrhythmias
Carotid artery puncture/cannulation
Infection**
58
Q

when you see a sudden dramatic increase in lactate, this would indicate what?

A

anaerobic metabolism

AP I (8 decks)

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