Art lines and CVCs

Question 1

what % of pts lack collateral blood flow?

Answer 1

5%

Question 2

after releasing pressure on the ulnar artery, flushing of the thumb confirms adequate collateral blood flow within how many seconds?

Answer 2

5 seconds

Question 3

what phenomenon has preexisting vascular insufficiency? (RP)

Answer 3

raynaud’s phenomenon

Question 4

Radial, brachial, ulnar, axillary, dorsalis pedis, or femoral artery:

1. increased incidence of infection and arterial thrombus?
2. don’t attempt if radial artery punctured?
3. high rate of kinking?
4. most common artery?
5. distorted waveform and far distance from aorta?
6. possible nerve damage and air/thrombi has quick access to cerebral circulation

Answer 4

1. femoral
2. ulnar
3. brachial
4. radial
5. dorsalis pedis
6. axillary

Question 5

what gauge is the arrow catheter?

Answer 5

20 gauge

Question 6

what gauge is the TB syringe needle?

Answer 6

27 gauge

Question 7

Degrees:

1. What degree do you penetrate the artery at?
2. What degree do you drop the needle down to before advancing it 1-2 mm?

Answer 7

1. 45 degrees

2. 30 degrees

Question 8

what device do we use to monitor perfusion adequacy to the limb the art line is in?

Answer 8

pulse oximeter

Question 9

Phlebostatic axis:

1. located at which intercostal space?
2. how far between the anterior-posterior diameter of the chest?

Answer 9

1. 4th ICS

2. halfway between AP diameter of the chest

Question 10

how many million CVCs are placed in the U.S. per year?

Answer 10

5 million

Question 11

what % of central line insertions have complications?

Answer 11

15%

Question 12

hematoma and arterial puncture are most common during which venous catheterization?

Answer 12

femoral

Question 13

IJ or SC:

1. more complications with pneumothorax?
2. more complications with arterial puncture & hematoma?

Answer 13

1. SC

2. IJ

Question 14

does SC or IJ have lower incidence of infection?

Answer 14

SC

Question 15

what is overall incidence % of infection in all CVC line sites?

Answer 15

2%

Question 16

incidence of catheter related infection rises with the number of days the catheter is in past what day number?

Answer 16

3

Question 17

incidence of infection with antiseptic coated catheters is reduced how many fold?

Answer 17

4 fold

Question 18

Thrombosis complications:

1. what % of MICU patients get a catheter related thrombosis?
2. what % of femoral catheters have a thrombosis?
3. what % of subclavians have a thrombosis?
4. IJ thrombosis is how many times a greater risk than subclavian?

Answer 18

1. 15%
2. 21.5%
3. 1.9%
4. 4 times

Question 19

chlorhexidine prep decreases catheter infection how many fold?

Answer 19

4 fold

Question 20

antibiotic coated catheters lower infection rate by what %?

Answer 20

50%

Question 21

inability to place CVC after 3 attempts increases complications how many fold?

Answer 21

6 fold

Question 22

practitioners with greater than 50 catheterizations have what fraction of less complications?

Answer 22

half

Question 23

Femoral placement:
what are 3 advantages?
1. high rate of what? (S)
2. no interference with what? (C)
3. no risk of what? (P)
what are 4 disadvantages?
1. increased what? (I)
2. increased what? (D)
3 decreased pt what? (M)
4. increased circulation time of what? (D)

Answer 23

1. success
2. CPR
3. pneumothorax
4. infection
5. DVTs
6. mobility
7. drug

Question 24

IJ placement:
what are the 4 advantages?
1. optimal access for who? (A)
2. what complication is uncommon? (P)
3. increased rate of what? (S)
4. what is controlled easily? (B)
what are the 4 disadvantage?
1. poor landmarks in what pts? (O)
2. not ideal for what type of access? (P)
3. increased incidence of what? (I)
4. difficult access for emergent what? (I)

Answer 24

1. anesthesia
2. pneumothorax
3. success
4. bleeding
5. obese
6. prolonged
7. infection
8. intubations

Question 25

Does L or R IJ placement have an increased risk of thoracic duct injury?

Answer 25

L IJ

Question 26

``` SC placement: what are the 3 advantages? (IC, BOL, LII) 1. increased what? (C) 2. better landmarks in what pts? (O) 3. lower incidence of what? (I) what are the 6 disadvantages? 1. increased risk of what? (P) 2. what is required for successful placement? (E) 3. frequent catheter what? (M) 4. inability to access from where? (H) 5. difficult placement during what? (C) 6. difficulty to control what? (B) ```

Answer 26

1. increased comfort 2. better obesity landmarks 3. lower infection incidence 1. pneumothorax 2. experience 3. malposition 4. HOB 5. CPR 6. bleeding,

Question 27

what is the site choice for severe hypovolemia?

Answer 27

subclavian

Question 28

The right IJ runs __1.____ to the sternocleidomastoid muscle in the upper neck, ____2.___to it in the triangle of the between the two inferior heads of the sternocleidomastoid muscle (SCM) in the middle of the neck, and ____3.___ the anterior portion of the clavicular head in the lower part of the neck.

Answer 28

1. medial 2. posterior 3. behind

Question 29

What is the proper CVC cm depth range for: 1. right subclavian 2. right IJ 3. left IJ

Answer 29

1. 13-14 cm 2. 15-16 cm 3. 17-18 cm

Question 30

Lateral or medial of the femoral pulse? 1. vein 2. nerve

Answer 30

1. medial | 2. lateral

Question 31

what insertion needle angle? 1. subclavian 2. femoral

Answer 31

1. 15 degrees | 2. 45 degrees

Question 32

intrajugular vein should not be deeper than how many cm?

Answer 32

2

Question 33

the subclavian vein in an adult is what range of cms long and what range of cms in diameter?

Answer 33

3-4 cm long & 1-2 cm in diameter

Question 34

what are the cm to right atrium? 1. subclavian 2. right IJ 3. left IJ 4. femoral 5. R AC 6. L AC

Answer 34

1. 15 cm 2. 20 cm 3. 25 cm 4. 30 cm 5. 40 cm 6. 45 cm

Question 35

what are the cm to right ventricle? 1. subclavian 2. right IJ 3. left IJ 4. femoral 5. R AC 6. L AC

Answer 35

1. 25 cm 2. 30 cm 3. 35 cm 4. 40 cm 5. 50 cm 6. 55 cm

Question 36

what are the cm to right pulmonary artery? 1. subclavian 2. right IJ 3. left IJ 4. femoral 5. R AC 6. L AC

Answer 36

1. 40 cm 2. 45 cm 3. 50 cm 4. 55 cm 5. 65 cm 6. 70 cm

Question 37

A wave: 1. increase atrial pressure cause by what? 2. correlates with what wave on an EKG?

Answer 37

1. R atrial contraction | 2. P wave

Question 38

C wave: 1. slight elevation of the tricuspid valve into the R atrium during when? 2. correlates with the end of what on an EKG?

Answer 38

1. early ventricular contraction | 2. QRS segment

Question 39

X descent: 1. probably caused by the downward movement of the what during systolic contraction? 2. occurs before what wave on an EKG?

Answer 39

1. ventricle | 2. T wave

Question 40

V wave: 1. what causes this wave? 2. occurs as what wave is ending on an EKG?

Answer 40

1. blood filling the right atrium comes up against a closed tricuspid valve 2. T wave

Question 41

Y descent: 1. what produces this descent? 2. occurs before what wave on an EKG?

Answer 41

1. tricuspid valve opens and blood goes to the right ventricle 2. P wave