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AP1 Final > Vascular Access > Flashcards

Vascular Access Flashcards

1
Q

how is fluid (water) volume distributed?

A

extracelluar (insterstitial & plasma) 35%

Intracellular 65 %

Blood volume (RBC & Plasm) 14%

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2
Q

what is true of osmolality?

A

its the count of the total number of particles in a solution

it is equal to the sum of the molalities of all the solutes present in that solution (osmol/kg)
Hyperosmotic
Hypoosmotic

the concentration of an osmotic solution per 1000 grams of solvent

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3
Q

what is the concentration of osmotic solution per liter of fluid

A

osmolarity

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4
Q

what produces osmotic pressure across cell membranes?

A

ions

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5
Q

what is oncotic pressure?

A

Large protein molecules produce colloid osmotic pressures (oncotic pressures) across capillary membranes

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6
Q

what is normal osmotic pressure?

A

285 mOsm/L

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7
Q

what is normal oncotic pressure?

A

28 mmHg

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8
Q

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

A

tonicity

(used in association to RBCs)

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9
Q

what is the term for 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

define hypertonic

A

Having a higher concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles

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11
Q

what happens to cells in hypertonic solution

A

cells shrink due to efflux of water

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12
Q

What is term for - Having a lower concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles.

A

hypotonic

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13
Q

what happens to cells in a hypotonic solution

A

cells expand due to influx of water.

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14
Q

What are normal values for Plasma Ca

A

8.5 -10 mEq/L

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15
Q

what are normal values for plasma Mg

A

1.5 - 2.5 mEq/L

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16
Q

what are normal plasma levels for PO4 and SO4

A

PO4 - 0.5 –1.5 mEq/L

SO4 - 0.3 - 0.6 mEq/L

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17
Q

what’s in D5W?

A

dextrose (5 g/l)

Water

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18
Q

what’s in 0.9 NaCl

A

Na - 154 meq/l

Cl -154 meq/l

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19
Q

what’s in LR?

A

Na - 130 meq/L

Cl - 109 meq/L

K - 4 meq/L

Ca - 3 meq/L

Lactate - 28 meq/l

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20
Q

what’s in plasma - Lyte?

A

Na - 140 meq/L

Cl - 98 meq/L

K - 5 meq/L

Mg - 3 meq/L

acetate

gluconate

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21
Q

what’s in hetastarch?

A

Na - 154 meq/L

Cl - 154 meq/L

hyrdoxyethyl starch

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22
Q

what’s in Dextran 70?

A

Na - 154 meq/L

Cl - 154 meq/L

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23
Q

Which IV fluids are hypotonic

A

D5W

LR (slightly)

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24
Q

which fluids are hypertonic?

A

slightly:

NS

plasma-lyte

hetastarch

dextran 70

5% albumin

extremely:

3% & 5% Na

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25
Q

which patients would you avoid giving LR?

A

patient’s getting blood (d/t Ca)

Renal failure

DM (kidney issues)

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26
Q

which crystalloid is ok to use for renal failure patients?

A

NS

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27
Q

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

A

tonicity of an IV fluid

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28
Q

what is true of . Extremely hypotonic and hypertonic solutions

A

may be infused in small volumes and into large vessels, where dilution and distribution are rapid

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29
Q

what are some issues that IV solutions may cause?

A

Tissue irritation
Pain on injection, and
Electrolyte shifts.
Inflammatory and
Enhanced clotting processes
Phlebitis and thrombophlebitis.

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30
Q

what is generally accepted upper limit for a peripheral IV fluid osmolarity?

A

900 mOsm/L

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31
Q

what is fluid replacement therapy for healthy adult?

A

100-200 ml/day GI
500-1000 ml/day insensible loss
1000 ml/day urinary loss

Total ~2500 ml/day

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32
Q

what is the 4-2-1 fluid maint. 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

33
Q

what is sensible fluid loss for surgeries?

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)

34
Q

what should urine output be?

A

MINIMUM 0.5ml/kg/hr

35
Q

Fluid calculation in simulated case for hystorectomy on 70kg female.

A

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

36
Q

what are examples of preoperative fluid losses

A

Bowel prep
Vomiting/diarrhea
Burns
Malnourished
Ascites
Pulmonary Effusion

37
Q

what are examples of operative fluid loss?

A

blood loss

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

38
Q

What can blood products improve that crystalloids can’t?

A

O2 carrying capacity (i.e. Hb)

39
Q

what is true of crystalloid fluids?

A

Crystalloids in sufficient amounts as effective as colloids in restoring intravascular volume.

Crystalloids require 3x volume of colloids/blood when replacing lost volume.

Rapid admin crystal >4L associated with tissue edema.

40
Q

what are advantages of colloids?

A

smaller infused volume

prolong increased plasma volume

less peripheral edema

greater O2 delivery

decreased thromboebolism risk (dextran)

41
Q

what are some disadvantages of colloids?

A

expensive

coagulopathy (decreaesed ability to clot)

decreased GFR

pulmonary edema

42
Q

what are the advantages of cyrstalloids?

A

less expensive

greater GFR

replace IFV losses

43
Q

What are some disadvantages of crystalloid?

A

short lived hemodynamic improvement

peripheral edema

pulmonary edema (conflicting data)

44
Q

Which crystalloid solution can cause hypochloremic metabolic acidosis?

A

NS

45
Q

which crystalloids would you use on patients that have Na restriction (i.e. CHF patients)

A

D5W

D5NS

46
Q

how long do colloid stay in the intravascular compartment?

A

albumin 3-4 hrs

Dextran 6 -12 hrs

hetastarch 6 -12 hrs (17 d)

47
Q

what colloid has a 1/2 life of 25.5 hours?

A

hetastarch

48
Q

what is cell saver composed of ?

A

on RBC, no clotting factors

49
Q

How much is HCT increased with each unit of PRBC?

A

3%

50
Q

how much is Hgb increase with each unit of PRBC?

A

1 g/dL

51
Q

What is true of Hgb and transfusion of PRBC recommendations?

A

rarely indicated for Hgb > 10 g/dL

almost always for Hgb < 6 g/dL

52
Q

What is true of PRBCs?

A

Admin pt. who require RBC but no volume
Carefully checked against blood slip and patient ID by 2 people
Transfusion w/170 micron filter
Blood warmed prior to infusion

53
Q

why is blood warmed prior to administration?

A

hypothermia can cause coagulation problems

54
Q

which is more sensitive a type & cross or a type & screen?

A

type and cross

(confirm ABO and Rh type)

actually mix blood together to confirm no reactions

55
Q

What are the transfusion recommendations for Platelets?

A

Plt < 50k increase Sx blood loss
Oncology Pt >10,000/mm3
Target > 100k/mm3
Each unit will increase count by 5-10k/mm3
Platelet phoresis pooled 6-8 donor (200-400 ml)
Admin. through 170 micron filter

56
Q

what is should not be done to platelets prior to administering?

A

do NOT warm them

57
Q

What are the transfusion recommendations for FFP

A

Contains all plasma proteins & factors II, V, VII, IX, X, XI, and AT III
Unit  clotting factors 2-3%
Should be warmed 37

58
Q

what is true of platelets and FFP

A

they do not have antigens do they do NOT have to be ABO typed

59
Q

what factors does cyropercipitate have?

A

VIII,

fibrinogen,

von Willebrand factor,

XIII

60
Q

what are indications for arterial lines?

A

BP monitoring
Blood sampling
Deliberate Hypotension

61
Q

what sites for arterial lines

A

Radial
Brachial
Femoral
Dorsalis Pedis

62
Q

what test should be done for collateral cirulation prior to inserting art. line?

A

Allen’s test (5 to 10 second refill)
Doppler
Pulse Oximeter

63
Q

which patient population has contraindications for radial and ulnar art. lines?

A

raynaud’s

64
Q

what are some risk associated with artery catherization?

A

Vascular thrombosis
Distal embolization
Proximal embolization
Vascular spasm

65
Q

why do we put in central Lines?

A

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

66
Q

what are contraindications to central venous catheterization?

A

R atrial tumors

Fungating tricuspid valve vegetations

Suspected injury to IVC or SVC

67
Q

what are central venous routes?

A

Peripheral Arm Veins (PICC)
Femoral vein
External jugular
Internal jugular*
Subclavian vein

68
Q

what technique is used for central venous catherization?

A

seldinger’s

69
Q

what are some complications associated with central venous lines?

A

Infection

Pneumothorax/hemothorax
Air embolism
Arrhythmias
Carotid artery puncture/cannulation

70
Q

What type of access for a 50 year old 70kg for 30 minute lap chole

A

peripheral

71
Q

what type of access for a 24 year old for 18 hour spinal fusion

A

art line

central line

peripheral

72
Q

what type of access for a 75 year old with CAD, HTN, CHF for total hip replacement

A

art line

central line

peripheral line

73
Q

What type of assess for a 46 year old with ESRD, MWF dialysis for AV fistula revision

A

peripheral (if you can get it)

74
Q

when evaluating ABGs, what could cause the Hct to increase? (no blood products have been given)

A

dehydration

75
Q

In regards to ABG evaluation, what would expect to see with an accute loss of blood?

A

decrease Hct

increase in lactate (anaerobic metabolism – metabolic acidosis b/c not enough oxygen being delivered to tissue due to blood loss)

76
Q

After administering PRBC, what would you expect to see in the ABG of a patient being treated for acute blood loss?

A

increase Hct

increase K (free K in PRBC)

decrease in Lactate (d/t citrate in blood)

77
Q

why does blood glucose increase with acute blood loss?

A

endogenous catecholamine release

78
Q
A

AP1 Final (3 decks)

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