Vascular Access and Monitoring Lecture Powerpoint

Question 1

What is intravenous access used for? (5)

Answer 1

• deliver fluid
• Deliver medication/IV contrast
• Give parental nutrition/electrolytes
• Deliver blood products/draw blood
• hemodialysis

Question 2

Reasons for an arterial line (3)

Answer 2

• measure constant blood pressure
• drawing ABGs
• measure central venous pressure

Question 3

Catheter sizing

Answer 3

Smaller the number gauge larger the bore of the needle

Question 4

Goal catheter size gauge for adequate flow rate upon catheterization

Answer 4

20 gauge, ideally 18 (easier for IV contrast)

Question 5

Peripheral IV access protocol (2)

Answer 5

• Can be done by many different healthcare providers

- should take 3 attempts, if cannot then second person tries, then if not IV team must be called

Question 6

Advantages (3) and disadvantages (3) for peripheral IV access

Answer 6

\+ease of insertion
\+ low cost
\+minimal complications
- short duration must be less than 3 days and cannot be used with certain medications
-easily occluded
-potential tissue injury

Question 7

If labs are not drawn immediately upon a peripheral IV access being established, then…

Answer 7

….cannot draw blood labs later on as they are no longer accurate (need a different site)

Question 8

Contraindications for peripheral IV establishment (7)

Answer 8

• If med can be given orally***
• cellulitis
• injury to extremity
• previous IV infiltration (IV not actually in vein)
• surgical procedures
• Burn
• AV fistula presence

Question 9

Why might establishing a peripheral IV be difficult? (5)

Answer 9

• Dehydration
• shock
• IV substance abuse
• Obesity or being underweight
• Chemo

Question 10

Typical placement areas of a peripheral IV (4)

Answer 10

• Dorsal hand
• forearm/wrist (cephalic or basilic vein)
• leg/ankle/dorsum of vein (greater saphenous vein)
• scalp in neonate

Question 11

Gauge size needed in resuscitation to get large amounts of fluid/medications fast

Answer 11

16 gauge

Question 12

Infiltration

Answer 12

Leakage of fluid or medications that can be given peripheral IV into surrounding tissue from being slightly pulled out causing swelling, discomfort, and burning

Question 13

Extravasation

Answer 13

Accidental administration of toxic medications that should not be given IV into tissue around the infusion site that can cause tissue necrosis, disfigurement, or loss of function

Question 14

Phlebitis

Answer 14

Blood clot in vein causing inflammation creating a red, warm, swollen, tender vein, common in superficial veins and don’t require concern but deep can increase risk for pulmonary embolism, indication to remove catheter

Question 15

Examples of drugs that can cause extravasation if given peripheral IV (6)

Answer 15

• Chemotherapy
• K+
• vancomycin
• cefotaxime
• amiodarone
• calcium chloride

Question 16

Indications for central venous catheter (6)

Answer 16

• Inadequate peripheral venous access
• administration of toxic medications (vasopressors, chemo, TPN)
• hemodynamic monitoring (measurement of CVP)
• extracorpeal (hemodialysis)
• rapid infusion of fluids/blood
• drawing frequent labs

Question 17

Contraindications for a central venous catheter (4)

Answer 17

• all relative as these can be life saving
• anatomic distortion or trauma for specific sites
• hemodyalysis or pacemaker presence
• moderate to severe coagulopathy

Question 18

PICC line

Answer 18

Central venous catheter inserted into cephalic, basilic, brachial vein into distal superior vena cava, less procedural risk than others as uses ultrasound guidance with an IV nurse with confirmation of placement via radiology, can be single or double lumen, used for temporary access infusion 15-30 days for things like IV antibiotics, chemo, or vasopressor medications, inserted in nondominant arm

Question 19

Order of preference for PICC line vein choice

Answer 19

Basilic > brachial > cephalic > median cubital

Question 20

Advantages (4) and disadvantages (2) of PICC line

Answer 20

\+ease of insertion
\+relatively safe and inexpensive
\+good for drawing several labs
\+easy to remove
-potential for occlusion
-can take over 1 hour to place, not stat

Question 21

PICC line complications (7)

Answer 21

• infection
• hemorrhage
• arterial puncture
• nerve injury
• pneumothorax
• thrombus
• phlebitis

Question 22

Non tunnel (Quinton) central venous catheter

Answer 22

Percutaneously inserted into internal jugular, subclavian, or femoral vein with the catheter exiting the skin, can be up to quadruple lumen, short term use only for emergent situations and accounts for majority of central line associated blood stream infections

Question 23

More lumens on a catheter increase higher rate of…

Answer 23

….venous thrombosis

Question 24

Tunneled (hickman, groshong, broviac) central venous catheter

Answer 24

Implanted internal jugular, subclavian, or femoral vein useful for long term as has lower rate of infection, has a dacron cuff that inhibits migration of organisms into catheter after skin grows over, only lumen is exposed everything else is hidden

Question 25

Central venous catheter advantages (4) and disadvantages (2)

Answer 25

\+long term access
\+decreased infection rate in tunneled
\+safe with most meds
\+emergency access
-requires surgical insertion often under sedation
-increased cost

Question 26

Implantable venous access port

Answer 26

Often used for same reasons as a tunneled central line, most often used for patient with chemotherapy, entirely under skin allowing for lowering risk of infection, can remain lifelong, much more cosmetic, medicines injected into skin thru catheter, after being filled reservoir slowly releases medicine into blood stream, except for flushing once a month no special care needed

Question 27

Intraosseous access

Answer 27

Used in emergency situations, presence of vascular collapse (due to shock as blood shunts to core), in children/infants, or in trauma, bone marrow functions as a noncollapsible venous access allowing meds and fluids to enter central circulation in seconds, should only be done for an avg of 5.2 hours

Question 28

Most common site of intraosseous access

Answer 28

Proximal tibia

Question 29

Intraosseous access advantages (3) and disadvantages (2)

Answer 29

\+rapid and easy to insert
\+low complication rate
\+safe with resuscitation meds
-short term only
-potential for osteomyelitis or fracture

Question 30

3 types of IV infusion pumps and complication (1)

Answer 30

• continuous infusion
• intermittent infusion (for like 3 antibiotic doses a day)
• patient controlled (PCA) (for narcotic pain control)

-still source of many injuries and some deaths secondary to infusion pump errors