Vascular Access P2 Flashcards
Lactated ringers are ____ and raise/lower Na levels.
hypotonic
lower
NS is ___%.
Does not contain ___.
Causes ____ _____ _____.
0.9
potassium
HYPOchloremic metabolic acidosis
What are D5W and D5NS good to replace?
pure H2O deficit
3% and 7.5 NaCL are extremely _____.
Cause severe _____ or _____ ____.
hypertonic
- hyponatremia
- hyovolemic shock
Examples of colloids (3):
- albumin
- dextran
- hetastarch
What fluid is often used for reattaching fingers, for example?
Why?
Dextran
We don’t want to vasoconstrict vessels by using phenylephedrine and keeps the vessels slippery. It also prevents clots from forming.
This colloid may cause hypocalcemia allergic reactions and impaired lung function
albumin
This colloid may cause hypotension.
albumin
This colloid may cause coagulopathy, renal dysfunction, anaphylaxis, and osmotic diuresis.
dextran
May cause coagulopathy and anaphylactoid reactions
hetastarch
Half life of hetastarch is ____ hours
25.5
What may be associated with increased bleeding, may prolong PT, aPTT, bleeding?
Prolong PT, bleeding if > ___ ml/kg
Hetastarch
Hextend
Hextend MW ≈ 670
20
Types of blood products: (6)
- PRBC
- FFP
- Cryoprecipitate
- platelets
- cell saver
- whole blood (we deliver in this form)
Transfusion triggers of when to give blood:
- acute/chronic anemia
- level of oxygen
- evidence of impaired oxygen carrying capacity
- rate/magnitude of blood loss
Estimate blood volume:
women: ___ ml/kg
men: ___ ml/kg
infants: ___ ml/kg
60
70
80
For each unit of PRBC transfused you can expect HCT to increase by ___% or Hgb to increase by ___gram/dL
3
1
Transfusion of PRBC 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 the anemia is acute.
10
6
Administer PRBC to patient who require RBC but no volume.
Transfuse with ___ micron filter.
Always to remember to do this before infusion:
170
warm blood
Give this type of blood to childbearing age women when in a hurry.
O-
What is important in childbearing women
Rh system
What compatability test confirms ABO and Rh type and detects other antibodies?
Type and cross
What compatability tests for top 100 antibodies?
type and screen
Platelets < ____ increase Sx blood loss
50k
Each unit of platelets increases ___-___ k/mm3
5-10k
Platelets pooled from ___-___ donors
6-8
Warm platelets before transfusing. True or false?
false
Contains all plasma proteins and factors II, V, VII, IX, X, XI and AT III
Fresh frozen plasma
Each unit increases clotting factors ___-___%
2-3
FFB have same infectious risk as PRBC. True or false?
true
Cryroprecipritate and FFP need to be ABO typed. True or false.
False
What factors does cryroprecipitate have? (4)
8
13
von Willebrand factor
FIBRINOGEN
Transfusion related Hep B risk
1/350k
Transfusion related Hep C and HIV risk
1 / 2million
Transfusion related febrile reaction risk:
1/200
Transfusion related anaphylactic risk:
1/25 - 50k
Ideal site for arterial cannulation
- easy access
- relatively superficial vessel
- non-torturous vessel
- collateral circulation distal to the site of cannulation
- migration of thrombogenic material will have minimal impact
Test for collateral circulation (3)
- Allen’s test (5-10 second refill)
- Doppler
- Pulse oximeter
Arterial cannulation sites (7)
- R
- U
- D
- B
- F
- P
- A
- radial
- ulnar
- dorsalis pedis
- brachial
- femoral
- posterior tibial
- axillary
Benefit to cannulating radial artery
- easy to cannulate
- easy access
- adequate collateral circulation (ulnar provides majority of blood flow to hand in 90% of patients)
Benefit to cannulating ulnar artery
- if majority of flow to hand is from radial artery then cannulate the ulnar.
- If multiple attempts have been made to the radial resulting in hematoma, do NOT use the ulnar!!
Radial and ulnar sites are contraindicated in patients with ______ _____.
Raynaud’s syndrom
Cannulating in the brachial artery contraindications:
- location close to elbow may cause kinking
- collateral vessels may not be adequate in older patients with vascular disease
Cannulating in the femoral artery contraindications
- prone to pseudoaneurysm
- atheroma formation following cardiac catheterization
- may be only access for burn or trauma victims or for thoracic aortic aneurysm
- high rate of ischemic complications
- higher rate of infection
Cannulating in the dorsalis pedis and posterior tibial points to keep in mind:
- reasonable alternaative to radial or ulnar artery
- not present in 5-12% of patients
- incidence of thrombolytic occlusion (8%)
- SHOULD NOT be used in patients with diabetes or peripheral vascular disease
- Allen’s test possible by blanching big toe
Cannulation in the axillary artery:
surrounds by the axillary nerve plexus–nerve damage
air or thrombus may quickly gain access to the cerebral circulation during flush
When placing art line, need:
- 20g IV catheter
- lidocaine
- 3ml syringe
- betadyne prep
- towel roll
- transducer
- 18g needle
How to put in the art line… (4)
- always explain to the patient
- determine best site
- place patients arm on secure board
- PERFORM ALLEN’S TEST
What to do when placing art line in:
- ensure hand is in optimal position
- palpate
- prep
- insert 20g catheter
- YES, DO USE STEEP ANGLE
- look for flash
- advance guide wire
- advance catheter
- remove stylet
- attach transducer tubing
Radial artery cannulation risks:
- vascular thrombosis
- distal embolization
- vascular spasm
- accidental drug injection
- infection
Why do we place central venous line? (7)
- pressure
- fluid
- food
- remove things
- pacing
- monitoring central venous pressure
- fluid administration
- infusion of caustic Rx
- total parental nutrition
- air emboli aspiration
- transcutaneous pacing leads
- poor peripheral access
Contraindication to central venous catheter:
- Right atrial tumors
- fungating tricuspid valve vegetations
Contraindications of central line catheterization relative to site:
- local sepsis
- previous vessel damage
- suspected injury to IVC or SVC
Central venous routes (5)
- Peripheral arm veins (PICC)–usually in basilic or cephalic, good for long term
- femoral vein
- external jugular
- internal jugular
- subclavian vein
Seldinger’s technique for inserting central venous line:
3 fingers up from sternal notch for central line placement
Central venous complications (5)
- pneumothorax/ hemothorax
- air embolism
- arrhythmia
- carotid artery puncture
- infection
What lines do we expect for a 24 y/o for 18 hour spinal fusion?
- 2 IVs?
- central line because arms are likely to be tucked
- A-line
What lines do you expect for a 75 y/o with CAD, HTN, CHF for total hip replacement?
2 IVs, art line
everything basically
46 y/o with ESRD, MWF dialysis for AV fistula revision lines would include:
IV
68 y/o for lap assisted colectomy
IV
1 unit of blood increases Hct
3 % points
Why does a steep increase in lactate indicate need to give blood?
Anaerobic metabolism is occurring and most likely it’s volume that is needed.
Liver failure patients have ______ lactate values.
increased
After blood is transfused, we would expect K to ____ and Ca to ______ .
- increases due to the presence of lysed cells
- decreases
- Blood celates calcium after blood is given
If we see increase in Hct in blood gas report, what do we expect has happened?
little dehydration is occuring
If sugar increases drastically in blood gas what has happened?
sympathetic response and catacholamine surge due to loss of blood
What is composed of chains of glucose with hydroxyethyl ether?
Hetastarch
What fluids are good to give people with Na restrictions?
D5W and D5NS
FFP needs exact cross and match. True or false?
false, does not
