Vascular Ch. 22 & 30

Question 1

Central venous access plays a vital role in care of critically ill patients and also used for

Answer 1

intravenous antibiotic therapy, chemotherapy, total parenteral nutrition

Question 2

Central vascular access devices (VAD) are catheters so the ______ resides in a central vein (_________)

Answer 2

terminal tip, most often superior vena cava

Question 3

Most common target vein for central VAD

Answer 3

basilic

Question 4

Initial puncture is made in the vessel and the tip resides in

Answer 4

superior vena cava

Question 5

Artriocaval junction is

Answer 5

distal 3rd of SVC

Question 6

What is the volume flow with VAD

Answer 6

high flow volume, 2000 mL/min

Question 7

Why is the basilic vein preferred for peripheral VAD placement

Answer 7

due to volume flow

Question 8

Lower extremity veins for VAD placement is more common in

Answer 8

neonates and children

Question 9

Which vessel is used for access in emergent situations

Answer 9

CFV

Question 10

Which is right IJV preferred for central VAD placement

Answer 10

has straighter course to heart

Question 11

External jugular may be used if IJV is occluded, this vessel is

Answer 11

more superficial and tortuous than the IJV

Question 12

Ultrasound guidance reduces failure of catheter placement as well as complications related to insertion because

Answer 12

non target puncture

Question 13

With ultrasound, it is important to assess

Answer 13

vessel patency, vessel diameter, relationship of IJV to CCA

Question 14

What should not be used for cannulation in patients with chronic renal insufficiency or chronic kidney disease. Why

Answer 14

subclavian/upper extremity; preserve for hemodialysis access

Question 15

Used for central venous access in emergency situations or when other sites are occluded

Answer 15

CFV

Question 16

Scanning technique and initial assessment

Answer 16

available patent vessels, location, assess size and patency

Question 17

____ will enlarge with neighboring _____ vein _______ or _______

Answer 17

collateral veins, larger vein, stenosis, thrombus

Question 18

Once VAD is placed, confirmation of appropriate tip placement is made with

Answer 18

xray

Question 19

What VAD complications can be reduced by using ultrasound guidance

Answer 19

pneumothorax, AV fistula, infection

Question 20

If artery is punctured, needle should be immediately removed and pressure applied to reduce chance of

Answer 20

hematoma

Question 21

Goal is to create an autogenous fistula as ________. Why

Answer 21

far distally as possible in nondominant arm; preserves proximal vessels for potential future access

Question 22

Why are upper extremities preferred for autogenous access

Answer 22

lower infection rate and easier access

Question 23

Autogenous fistulas have better

Answer 23

long term patency (40-70%) than synthetic grafts

Question 24

If arterial system is acceptable (_______ with no significant abnormalities), then proceed to venous system

Answer 24

diameters >2mm

Question 25

Diameter of veins should be recorded along entire length and must be greater than

Answer 25

2.5mm

Question 26

You will need to document

Answer 26

depth, wall thickness, calcification, location of thrombus

Question 27

What arterial vessels should have a diameter greater than 2mm

Answer 27

radial, ulnar, brachial

Question 28

Vein diameters should be

Answer 28

> 2.5mm

Question 29

Vein walls should

Answer 29

compress completely

Question 30

In the venous system, _____ makes the vessel unusable

Answer 30

thrombosis

Question 31

What is the Brescia-Cimino fistula

Answer 31

cephalic vein connected to distal radial artery at wrist

Question 32

For AV access, what other distal forearm vessel can be used

Answer 32

basilic instead of cephalic

Question 33

For AV access, basilic vein must be ____ and _____ to

Answer 33

transposed, juxtaposed, connect to distal artery

Question 34

Fistula maturity should take

Answer 34

8-12 weeks

Question 35

B-mode used to assess for what abnormalities

Answer 35

stenotic valves, thrombus, calcifications

Question 36

For volume flow measurement, what size should your sample volume be

Answer 36

large

Question 37

In a normal fistula

Answer 37

valves should not be visible, PSV between 150-300 cm/s, volume flow >800mL/min

Question 38

What is an abnormal finding of AV graft

Answer 38

valve projecting into lumen

Question 39

Why should a valve projecting into the lumen be evaluated

Answer 39

it can be a source of stenosis development

Question 40

Stenosis within venous outflow segment usually a result of

Answer 40

intimal hyperplasia