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AP Exam 2 > Vascular Access P2 > Flashcards

Vascular Access P2 Flashcards

1
Q

Lactated ringers are ____ and raise/lower Na levels.

A

hypotonic

lower

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2
Q

NS is ___%.

Does not contain ___.

Causes ____ _____ _____.

A

0.9

potassium

HYPOchloremic metabolic acidosis

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3
Q

What are D5W and D5NS good to replace?

A

pure H2O deficit

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4
Q

3% and 7.5 NaCL are extremely _____.

Cause severe _____ or _____ ____.

A

hypertonic

  • hyponatremia
  • hyovolemic shock
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5
Q

Examples of colloids (3):

A
  • albumin
  • dextran
  • hetastarch
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6
Q

What fluid is often used for reattaching fingers, for example?

Why?

A

Dextran

We don’t want to vasoconstrict vessels by using phenylephedrine and keeps the vessels slippery. It also prevents clots from forming.

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7
Q

This colloid may cause hypocalcemia allergic reactions and impaired lung function

A

albumin

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8
Q

This colloid may cause hypotension.

A

albumin

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9
Q

This colloid may cause coagulopathy, renal dysfunction, anaphylaxis, and osmotic diuresis.

A

dextran

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10
Q

May cause coagulopathy and anaphylactoid reactions

A

hetastarch

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11
Q

Half life of hetastarch is ____ hours

A

25.5

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12
Q

What may be associated with increased bleeding, may prolong PT, aPTT, bleeding?

Prolong PT, bleeding if > ___ ml/kg

A

Hetastarch

Hextend

Hextend MW ≈ 670

20

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13
Q

Types of blood products: (6)

A
  • PRBC
  • FFP
  • Cryoprecipitate
  • platelets
  • cell saver
  • whole blood (we deliver in this form)
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14
Q

Transfusion triggers of when to give blood:

A
  • acute/chronic anemia
  • level of oxygen
  • evidence of impaired oxygen carrying capacity
  • rate/magnitude of blood loss
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15
Q

Estimate blood volume:

women: ___ ml/kg
men: ___ ml/kg
infants: ___ ml/kg

A

60

70

80

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16
Q

For each unit of PRBC transfused you can expect HCT to increase by ___% or Hgb to increase by ___gram/dL

A

3

1

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17
Q

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.

A

10

6

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18
Q

Administer PRBC to patient who require RBC but no volume.

Transfuse with ___ micron filter.

Always to remember to do this before infusion:

A

170

warm blood

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19
Q

Give this type of blood to childbearing age women when in a hurry.

A

O-

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20
Q

What is important in childbearing women

A

Rh system

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21
Q

What compatability test confirms ABO and Rh type and detects other antibodies?

A

Type and cross

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22
Q

What compatability tests for top 100 antibodies?

A

type and screen

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23
Q

Platelets < ____ increase Sx blood loss

A

50k

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24
Q

Each unit of platelets increases ___-___ k/mm3

A

5-10k

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25
Q

Platelets pooled from ___-___ donors

A

6-8

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26
Q

Warm platelets before transfusing. True or false?

A

false

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27
Q

Contains all plasma proteins and factors II, V, VII, IX, X, XI and AT III

A

Fresh frozen plasma

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28
Q

Each unit increases clotting factors ___-___%

A

2-3

29
Q

FFB have same infectious risk as PRBC. True or false?

A

true

30
Q

Cryroprecipritate and FFP need to be ABO typed. True or false.

A

False

31
Q

What factors does cryroprecipitate have? (4)

A

8

13

von Willebrand factor

FIBRINOGEN

32
Q

Transfusion related Hep B risk

A

1/350k

33
Q

Transfusion related Hep C and HIV risk

A

1 / 2million

34
Q

Transfusion related febrile reaction risk:

A

1/200

35
Q

Transfusion related anaphylactic risk:

A

1/25 - 50k

36
Q

Ideal site for arterial cannulation

A
  • easy access
  • relatively superficial vessel
  • non-torturous vessel
  • collateral circulation distal to the site of cannulation
  • migration of thrombogenic material will have minimal impact
37
Q

Test for collateral circulation (3)

A
  • Allen’s test (5-10 second refill)
  • Doppler
  • Pulse oximeter
38
Q

Arterial cannulation sites (7)

  • R
  • U
  • D
  • B
  • F
  • P
  • A
A
  • radial
  • ulnar
  • dorsalis pedis
  • brachial
  • femoral
  • posterior tibial
  • axillary
39
Q

Benefit to cannulating radial artery

A
  • easy to cannulate
  • easy access
  • adequate collateral circulation (ulnar provides majority of blood flow to hand in 90% of patients)
40
Q

Benefit to cannulating ulnar artery

A
  • 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!!
41
Q

Radial and ulnar sites are contraindicated in patients with ______ _____.

A

Raynaud’s syndrom

42
Q

Cannulating in the brachial artery contraindications:

A
  • location close to elbow may cause kinking
  • collateral vessels may not be adequate in older patients with vascular disease
43
Q

Cannulating in the femoral artery contraindications

A
  • 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
44
Q

Cannulating in the dorsalis pedis and posterior tibial points to keep in mind:

A
  • 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
45
Q

Cannulation in the axillary artery:

A

surrounds by the axillary nerve plexus–nerve damage

air or thrombus may quickly gain access to the cerebral circulation during flush

46
Q

When placing art line, need:

A
  • 20g IV catheter
  • lidocaine
  • 3ml syringe
  • betadyne prep
  • towel roll
  • transducer
  • 18g needle
47
Q

How to put in the art line… (4)

A
  • always explain to the patient
  • determine best site
  • place patients arm on secure board
  • PERFORM ALLEN’S TEST
48
Q

What to do when placing art line in:

A
  • 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
49
Q

Radial artery cannulation risks:

A
  • vascular thrombosis
  • distal embolization
  • vascular spasm
  • accidental drug injection
  • infection
50
Q

Why do we place central venous line? (7)

  • pressure
  • fluid
  • food
  • remove things
  • pacing
A
  • monitoring central venous pressure
  • fluid administration
  • infusion of caustic Rx
  • total parental nutrition
  • air emboli aspiration
  • transcutaneous pacing leads
  • poor peripheral access
51
Q

Contraindication to central venous catheter:

A
  • Right atrial tumors
  • fungating tricuspid valve vegetations
52
Q

Contraindications of central line catheterization relative to site:

A
  • local sepsis
  • previous vessel damage
  • suspected injury to IVC or SVC
53
Q

Central venous routes (5)

A
  • Peripheral arm veins (PICC)–usually in basilic or cephalic, good for long term
  • femoral vein
  • external jugular
  • internal jugular
  • subclavian vein
54
Q

Seldinger’s technique for inserting central venous line:

A

3 fingers up from sternal notch for central line placement

55
Q

Central venous complications (5)

A
  • pneumothorax/ hemothorax
  • air embolism
  • arrhythmia
  • carotid artery puncture
  • infection
56
Q

What lines do we expect for a 24 y/o for 18 hour spinal fusion?

A
  • 2 IVs?
  • central line because arms are likely to be tucked
  • A-line
57
Q

What lines do you expect for a 75 y/o with CAD, HTN, CHF for total hip replacement?

A

2 IVs, art line

everything basically

58
Q

46 y/o with ESRD, MWF dialysis for AV fistula revision lines would include:

A

IV

59
Q

68 y/o for lap assisted colectomy

A

IV

60
Q

1 unit of blood increases Hct

A

3 % points

61
Q

Why does a steep increase in lactate indicate need to give blood?

A

Anaerobic metabolism is occurring and most likely it’s volume that is needed.

62
Q

Liver failure patients have ______ lactate values.

A

increased

63
Q

After blood is transfused, we would expect K to ____ and Ca to ______ .

A
  • increases due to the presence of lysed cells
  • decreases
  • Blood celates calcium after blood is given
64
Q

If we see increase in Hct in blood gas report, what do we expect has happened?

A

little dehydration is occuring

65
Q

If sugar increases drastically in blood gas what has happened?

A

sympathetic response and catacholamine surge due to loss of blood

66
Q

What is composed of chains of glucose with hydroxyethyl ether?

A

Hetastarch

67
Q

What fluids are good to give people with Na restrictions?

A

D5W and D5NS

68
Q

FFP needs exact cross and match. True or false?

A

false, does not

AP Exam 2 (5 decks)

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