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block 12 module 4 > Vascular shunts and access > Flashcards

Vascular shunts and access Flashcards

1
Q

type of vascular access that is mostly used in clinical practice

A

venous

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2
Q

types of venous access

A

peripheral

central

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3
Q

most common site for percutaneous peripheral catheterization

A

dorsal vein of the hand

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4
Q

why insertion to the lower extremeties is avoided in percutaneous peripheral catheterization

A

to avoid DVT

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5
Q

gauge number for bolus infusion

A

14

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6
Q

Gauge 14 is used for

A

bolus infusion

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7
Q

Gauge 18 is used for

A

volume transfusion

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8
Q

Gauge 16 is uaws for

A

rapid volume infusion

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9
Q

in neonates with fragile veins what gauge num is used

A

24

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10
Q

these are utilized before there were silicone and plastic sets

A

butterfly vein set

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11
Q

common sites for scalp vein cannulation for pedia

A

superficial temporal v
posterior auricular
supratrochlear

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12
Q

Emergency procedure in which the vein is exposed
surgically and then a cannula is inserted into the vein
under direct vision

A

peripheral venous cut down catheterization

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13
Q

why peripheral vein cut-down catheterization is not a favored procedure

A

relative morbidity
relative short patency
technical difficulty in dehydrated and hypotensive patients

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14
Q

primary choice for peripheral venous cut down catheterizatoin

A

great saphenous vein

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15
Q

advantage of central venous access

A
  • long term use
  • allows infusion of solutions that are too concentrated or irritating for the peripheral v
  • allow monitoring of central venous pressure
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16
Q

important indications for central venous access

A

chronically ill px requiring repeated venous punctures for blood sampling and medication

  • emergency access
  • critical care monitoring pwp
  • introduction of pacemakers
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17
Q

if you want to introduce pacemaker what access should you do

A

central venous access

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18
Q

absolute contraindications for central venous access

A

overlying skin and soft tissue infection

thrombophlebitis

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19
Q

why you should not insert a catheter through a thrombus vein

A

you will be removing the thrombus and cause embolus

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20
Q

what are the veins that are utilized in percutaneous polyethylene catheters

A

internal jugular
subclavian
femoral

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21
Q

preferred percutaneous catheterization for long term treatment needs

A

silicone catheters

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22
Q

borders of sedillot’s triangle

A

Sternal head of SCM medially
─ Clavicular head of SCM laterally
─ Superior border of the medial third of the clavicle
inferiorly

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23
Q

most utilized approach for percutaneous subclavian vein catheterization

A

infraclavicular approach

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24
Q

Junction of medial one-third and lateral twothirds

of clavicle

A

clavicular break

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25
Q

most common veins used in PICC line

A

saphenous or antecubital vein

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26
Q

indications for PICC

A

TPN
Blood sampling
administration of all medications

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27
Q

PICC line eliminate problems of

A

pneumothorax
air embolism
cardiac arrhythmia

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28
Q

disadvantage of PICC line

A

increased occlusion rate (small size)

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29
Q

Device of choice for patients who require long term or

even permanent access

A

implantable venous access device

30
Q

advantages of implantable venous access device

A

less infection
less restriction of act
L altered body image
L dressing changes

31
Q

method for accessing non collapsible venous plexuses thru the bone marrow cavity to systemic circulation

A

intraosseus access

32
Q

what does the intraosseus method access

A

non-collapsible venous plexus thru the Bone marroy cavity

33
Q

why intraosseus access was reintroduced in the 1980s

A

for rapid fluid infusion during resuscitation

34
Q

previous guideline in intraosseus access

A

only children 6 or younger

35
Q

sites for intraosseus access

A 
areas that mature slowly
Proximal Tibia below the growth plate
Distal tibia above the medial malleolus
Distal femur
ASIS
36
Q

Contraidnications of intraosseous access

A
  • Fractures and crush injuries near the access site
  • Fragile bone e.g. Osteogenesis imperfecta
  • Previous attempts to access in the same bone
37
Q

if venous accesss is not available w/in 1 min in a child with CP arrest what should you do

A

IO cannulation

IO needle placed in anterior tibia

38
Q

indications for catheterization of Umb V

A

IV access in low birth weight infants (not more than
2 weeks)
Emergency IV access for resuscitation, medication,
and fluids
Blood sampling
Monitoring of central venous pressure
Exchange transfusion in the newborn

39
Q

indications for catheterization of Umb A

A 
Continuous blood-pressure monitoring
Exchange transfusion in the newborn
Arterial blood gas sampling
Infusion of resuscitation drugs
Infusion of maintenance solutions
40
Q

risks in umb v/a catheterization

A

cardiac perforation
pericardial tamponade
portal HPN

41
Q

if the catheter is incorrectly placed in the RA during umb v/a cat what could happen

A

cardiac perforation or pericardial tamponade

42
Q

this assess blood gases and to continuously monitor blood
pressure (critically ill patients), invasive radiologic
interventional procedures

A

arterial vascular access

43
Q

sites used in arterial vascular access

A

radial axillary
femoral
posterior tibial
dorsalis pedis

44
Q

what arterydo most interventional cardiologist utilize for coronary angiogram?

A

radial artery

45
Q

arteries that should be avoided in arterial vascular access

A

brachial

temporal

46
Q

what would you perform first if you want to access arteries of the hand

A

allen’s test esp in px with peripheral arteriosum causing dse

47
Q

why allen’s tetst is performed before radial artery cannulation

A

to determine wheter ulnar collateral circulation to the hand is adequate in case of radial art thrombosis

48
Q

most commonly cannulated artery

A

radial

49
Q

why ulnar artery is less commonly used

A

bcoz of its proximity to the ulnar nerve

50
Q

this is used to make a passage or anastomosis btn 2 natural channels

A

vascular shunts

51
Q

this is used for damage control surgery

A

vascular shunts

52
Q

indications for temporaray intravascular shunting

A

Open extremities fractures with extensive soft tissue
injury and concurrent arterial injury (Gustillo IIIC)
Need for perfusion during complex vascular
reconstruction
Damage control for patients in extremities
Perfusion prior to limb replantation
Truncal vascular control
Complex repair of zone III neck injuries

53
Q

Used to graft aneurysms, to bypass occlusion or served

as catheterizing device especially in trauma

A

temporary limb salvage shunt

54
Q

this is used for blockade of the common carotid artery

A

brachial artery shunt

55
Q

this shunt istemporarily installed to maintain perfusion
towards the brain while removing the thrombus
area (thickened intima)

A

brachial artery shunt

56
Q

this is used in congenital anomalies esp TOF

A

modified Blalock taussig shunt

57
Q

what arteries are connected in B-T shunt

A

pulmo and subclavian

58
Q

Surgically created connection between a vein and an

artery

A

av fistula

59
Q

av fistula is usually in

A

forearm

60
Q

this allow access to the vascular system for adequate blood

flow during hemodialysis

A

av fistula

61
Q

why av fistula is superior to graft and catheters

A

Increased patency
Decreased morbidity
Decreased cost

62
Q

gold standard for hemodialysis access

A

av fistula

63
Q

advantages of av fistula

A

good flow for dialysis
last longer
less likely to get infected or cause blood clots

64
Q

disadvantages of av fistula

A

requires 2-3 mos to develop or mature
requires good inflow artery and good outflow vein
Vein mapping sometimes needed

65
Q

acute complications of vascular access

A

Pneumothorax
Vascular damage (perforation, dissections)
Air embolism
Aberrant catheter placement
Damage to the thoracic duct
Cardiac complications (Cardiac irritation, cardiac
perforation)
Local tissue trauma or damage (bleeding into
surrounding tissues, nerve injury)

66
Q

long term complications of vascular access

A 
Infection and sepsis
catheter induced septicemia
Thrombotic complications (DVT, pulmonary
embolus)
Phlebitis of the cannulated vessel
Superior vena cava syndrome
Catheter dislodgement and migration
67
Q

A 5 day old infant has to undergo arterial blood
gas monitoring, which is the best access site to
be used?

A

umbilical artery

68
Q

Patient ICU needs total parenteral nutrition.

Which is the best catheter to be used for this?

A

peripherally inserted central catheter

69
Q

Which CVC site is the easiest access in a trauma

code situation

A

femoral

70
Q

Considered in hemodialysis patients who are older
and/or has small veins and are not considered
good candidates for AV fistula.

A

av graft

71
Q

Beneficial for cancer patients who requires

repeated access for chemotherapy

A

implantable venous access device

72
Q

What is the ideal time to use a winged infusion set?

A

for IV push drugs

block 12 module 4 (2 decks)

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